“By and large we find trusts will stick to the benefit contract that the provider, in other words the insurer, offers for a fully insured or comprehensive client,” agrees Amy Osmond, senior employee benefits consultant at Lorica Consulting.
“Trusts in reality only provide more choice and control if an organisation wants to take a really hands-on approach to running its healthcare benefits,” continues Jelf’s Judge. “Some firms will move to a trust but simply lift the benefits they had and replicate them within a trust,” he adds.
Nevertheless, a well-administered trust can mean less propensity for blank cheque signing, emphasises Saunders. At Healix, for example, claims administration is done by specialist nurses who will decide on the most appropriate clinical pathway, and even whether to go NHS or private.
“Evidence-based medicine is very important. For example, we have an oncology specialist nurse who will know that a course of Herceptin is going to be so much and what the signs are a patient is responding or not to the treatment,” he says. “If in their local area there is a particular NHS centre of excellence then it might of course be medically beneficial for them to go there, with the saving coming back to the employer. But that is not a directive; it has to be on the basis that it is the best treatment for the member,” he adds.
Lorica’s Osmond points out that another way to control costs it is agreed to put in a service level agreement whereby the insurer gives money back in the contract year if their procedure code for treatment goes up by more than a certain percentage on a linear scale.
So, whatever the CC finally concludes, there does appear to be a trend towards more open referral and more interrogation of the process, and the chances are we will see more insurers following or at least imitating the sort of approach players such as Aviva and Bupa are already beginning to take, predicts Jelf’s Judge.
“I can start to see insurers taking more control of treatment plans and not just sitting and waiting for someone they have never met to decide how they should spend their money,” he says.