• Due to the complexity of the PMI market, it is more important than ever that PMI providers offer a range of products which cater for the needs of their different customers.
• There were over 3.3 million GP referrals for out-patient treatment through the NHS in Q3 of 2017/181.
• Vitality’s differentiated approach offers members three alternative hospital lists which members can select to suit their geographic location, as well as a directional care pathway to provide both the most appropriate cover, and offer the most seamless patient journey.

The role of hospital lists in providing appropriate cover

For the average PMI customer, the key purchasing driver is likely to be the desire for quick access to treatments which may either not be available or have a long waiting time attached if delivered through the public system. However, the PMI market and the healthcare system itself can be difficult to navigate, meaning it is more important than ever that PMI providers offer a range of products which cater for the needs of their different customers.
Traditionally, providers will offer a degree of choice in the products available to consumers – cover options such as variable out-patient limits and additional cover modules for therapies or mental health treatment allow the customisation of cover, and often of the premium consumers will need to pay. A key consideration within this is the Hospital List, the industry’s traditional means of specifying at which hospitals treatment should be carried out. For consumers, the concept of a hospital list is intuitive – selecting a list which covers either their most local or convenient hospitals, or the hospitals they deem to be the highest quality, or at which their favoured specialists operate, makes practical sense, and is a simple way to ensure that their cover is appropriate.

Complexities in the patient journey

But is this the best way to ensure people receive the best, and most appropriate treatment? While hospital lists work effectively in allowing members to tailor their cover by their geographic location – – they do not in themselves address the complexities of the treatment journey.

Usually, in order to access private treatment and healthcare, such as specialist treatment, patients would first need a GP referral. This poses a number of challenges, both in terms of speed of access, and in ensuring that the patient sees the most appropriate specialist for their condition. The majority of GP referrals for private treatment are still obtained through the NHS, and demand is high – there were over 3.3 million GP referrals for out-patient treatment through the NHS in Q3 of 2017/18. However, the pressures on NHS primary care services have been well-documented, with the average wait time for an appointment being 13 days as of 20172. This means that individuals seeking private treatment can often face long waiting times due to the need to obtain an initial referral from the public system, partly negating the benefit of purchasing PMI cover. In addition, increasingly it is being questioned whether the individual GP is always best-placed to provide a recommendation as to which hospital, and which specialist, an individual should be treated by. A high proportion of private treatment, however, is carried out on a named referral basis, whereby this is specified by the initial GP, causing potential issues from an eligibility and appropriateness perspective.

An alternative approach adopted by many providers is open referral – or directional care. This removes the need for a GP to recommend a specific specialist, and instead simply requires them to advise on the treatment which is required. The insurer will then recommend a specialist from their recognised list of providers to carry out the treatment. This approach in itself is not without its challenges, which has meant that open referral can often be dictated by cost, rather than purely on the quality and appropriateness of the specialist. Individuals accessing healthcare are therefore caught between two sub-optimal approaches – one in which specialists are being recommended by a GP who may not be in the best position to recommend the most appropriate consultant, and the other in which an insurer may direct them to a more cost-efficient consultant, rather than to the most appropriate.

Vitality’s differentiated approach

Clearly, challenges exist in managing the patient journey, and ensuring appropriateness of cover and quick access to treatment. VitalityHealth’s product addresses each of these needs.

Customers are able to access the healthcare system quickly and easily through Vitality GP – a market-leading virtual GP solution – and discounted provision of face-to-face private GP services. In addition, for common, highly-used treatments, such as physiotherapy and CBT or counselling, members can self-refer to treatment, and do not therefore need to obtain a GP referral. All of this lessens the burden on GPs and the public sector to act as a gatekeeper to the private system.

Furthermore, VitalityHealth use a combination of optional hospital lists – three alternative lists which members can select to suit their geographic location and needs (including an option covering all Central London hospitals) – and directional care, to provide both the most appropriate cover, and offer the quickest and most seamless patient journey. Consultant Select is a unique doctor-led directional care product, through which quality-assured specialists are recommended to members by an impartial Consultant Panel. This ensures that quality of specialist and their appropriateness to treat a member’s condition is always the key consideration, rather than cost. This pathway also focuses on making the customer journey as simple as possible – it is fully integrated with Vitality GP, and the Consultant Panel takes responsibility for managing the claim, booking appointments and arranging authorisation with VitalityHealth, significantly enhancing the patient experience. This is backed up by the performance of the product, with 98% of appointments taking place within 10 days of the original referral, significantly quicker than other directional care products in the market.

This all means VitalityHealth’s approach continues to be differentiated, and to respond to the changing trends and issues within the healthcare space. In doing so it is delivering more efficient and beneficial outcomes for all stakeholders, and most importantly, is fulfilling its goal of providing the quick and seamless access to treatment which consumers are looking for in a PMI product.