Senior EBCs urge PMI market to continue move to Open Referral

Panellists including Aitken agreed that in spite of the challenges of dealing with procurement departments which are focused on cutting costs in the short-term, more sophisticated discussions around strategy are still possible.

Xafinity’s Austin said: “Actually you [one] can have a far better strategic debate about procurement because a lot of their brief is about risk management outside of healthcare. Healthcare is being dragged into risk management and because risk management is all about a long-term strategic fix and not short-term sticking plasters, it’s a debate a lot of them are open to having.”

In light of the challenges facing the PMI market, participants at the Briefing said they were pleased with the emergence of one long-term strategy that they believe could change the gamefor the better. The decision by Bupa, the largest provider in the PMI industry, to roll-out its so-called “Open Referral” system at the turn of the year was widely applauded by panellists during the Briefing.

Essentially, Open Referral means that instead of referring patients directly to a named consultant of their choosing, GPs have to provide them with a referral for a procedure with no named consultant. The member will then call Bupa to preauthorise the diagnostic procedure or treatment they need and, provided this is covered by the policy, they will be provided with a choice of consultants at nearby hospitals. The member can then book their consultant appointment. The system has angered some consultants and hospital groups, who claim that Open Referral is part of an ongoing Bupa initiative to direct patients to healthcare facilities who charge the lowest price rather than offering patients the best quality hospitals and doctors.

But participants at the Briefing said that the strategy, coupled with Bupa’s tough stance with BMI Healthcare, Britain’s largest hospital group, over costs, could work well for the industry in the long-term.

Xafinity’s Austin said: “We all applaud Bupa for having taken the stance that they took with BMI and indeed with its Open Referral initiative. I think it’s good to see the market leader leading the market.”

Andrew Aldana of Thomsons Online Benefits, the advisers, added: “I applaud Bupa’s way of doing it. You still have got choice; they still offer a choice of consultants and hospitals. Clients can’t have it both ways; they can’t complain about the cost and medical inflation and on the other hand complain that they’re going to a system they don’t like. I think it’s the way to go for the rest of the market.”

In fact, variations of Open Referral are already active in some parts of the PMI market, participants pointed out. Aviva UK Health’s Reynolds, who believes Open Referral has “immense value strategically moving forward”, said that around 15% of all new claims at his organisation are coming in on an Open Referral-style basis.

Larry Bulmer of intermediary ADVO Group added: “A lot of insurers have been happily doing ‘soft’ Open Referral for many years. People ring up and they’re directing it differently. It’s not quite case management, it sort of sits between two schools when they’re doing it.”

Participants were cautious,however, about what kind of impact Open Referral-style approaches will have on the customer or patient experience.

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