Designing a sustainable healthcare scheme


4 key areas in healthcare scheme design

There are four key areas when designing and managing a healthcare scheme that can have a significant impact on its affordability and sustainability.  At Healix we use our clinical expertise to recommend benefit packages and clinical pathways designed to optimise the achievement of your healthcare objectives within your budget, ensuring good clinical outcomes in all cases.

The four key areas where Healix’s expertise in scheme design can make a dramatic difference relate to the management of care for:

  1. Cancer
  2. Musculoskeletal (MSK) issues
  3. Mental Health issues
  4. High Cost and Complex Claims

Cancer Care

Advances in cancer treatments have led to significant increases in costs and while most employers would like to provide the fullest cover possible for their employees, this usually needs to be achieved within budgetary constraints.

We work with an independent advisory board consisting of NHS and private practice oncology specialists to ensure the latest treatment and drug developments are at the forefront of our clinical pathways. We will advise you on a range of benefit options and their likely cost implications to help you decide what is most appropriate for your employees and the sustainability of your healthcare scheme.

All options have the welfare of the patient at heart and if private treatment is not fully covered under your scheme, our nurses will provide support and manage treatment through the NHS.

Musculoskeletal (MSK) Treatment

While the cost of individual claims for musculoskeletal treatment is not necessarily high, the frequency of such claims means that the overall cost to a healthcare scheme is significant.  To help reduce your costs while ensuring prompt treatment and service excellence, we have developed an MSK clinically-led treatment pathway in conjunction with one of our network partners.

If you choose to adopt this pathway, your scheme members would be directed to our network partner without the need to get a referral from their GP, allowing them to access treatment quicker and saving time off work for a GP appointment. Where clinically appropriate they will be given an initial telephone assessment with a senior therapist who would then book an appointment as necessary.

Treatment can also be available outside our partner network but in these cases, a GP referral would still be required and we would recommend a monetary cap.

Mental Health Treatment

Mental health is a growing area of concern with greater focus being placed on this key health and wellbeing issue. By partnering with leading mental health treatment providers, we are able to offer you attractive options in the provision of mental health care for your scheme members.

Options include inpatient as well as outpatient treatment at our partners’ extensive network of hospitals and clinics and if you choose not to include private inpatient treatment, we will provide support in clinically managing members into the NHS. We also provide options for self-referral or GP referral and the option to include monetary limits. The key is flexibility in designing a benefit package for optimum fit with your corporate healthcare objectives and budget.

High Cost & Complex Cases

To ensure that appropriate care pathways are being followed and that members are given any extra support and advice they may need, all high cost and complex cases are regularly reviewed by our team of nurse case managers. Furthermore, all cancer cases and any cases incurring costs over £20,000 are also overseen by our Clinical Support Team.

We also ensure that your members are treated in the most appropriate facilities giving due regard to clinical quality as well as cost effectiveness and if necessary, we will refer cases to our board of independent specialists to ensure treatment is clinically appropriate.

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