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UnitedHealthcare Gatekeeper Plan

In 2015, UnitedHealthcare launched a $0 premium HMO plan, in addition to their existing HMO plan. These plans are very similar in benefits, however, the $0 premium plan, referred to as the “gatekeeper plan” requires a referral. The idea behind this plan is to ensure that a patient recognizes the importance of their relationship with their primary care provider.

UnitedHealthcare and Optum Medical Network feel that establishing a relationship with a primary care provider (PCP) is the key to a patient’s overall health. A PCP is trained to care for a patient in a holistic way. This includes physical, emotional, social and mental health needs. A PCP understands how life stressors (i.e. family, friends, economic, work, etc.) can affect a person’s health in both positive and negative ways. The PCP is a valuable resource to patients with no current health issues for preventive health and screening as well as those with chronic medical conditions (diabetes, coronary artery disease, lung disorders, high blood pressure, etc). PCP’s are critical for medication review to make sure a patient’s medicines are safe to take together. He/she will review medications for interactions, advise of potential side effects and can even reduce medication cost and help to identify equally effective generic medications when appropriate. They can provide you with urgent and emergency care recommendations and appropriate places of care for those issues. Through building a long standing, trusted relationship with a PCP, a patient’s journey through life and the healthcare system can be much less stressful and more enjoyable. Let’s face it, we all are going to utilize the healthcare system, an established PCP relationship can be much more rewarding and critical to ensure better outcomes for health. In order to complete a referral quickly and easily, our providers can navigate to the portal at: www.optummedicalnetwork.com.

The Primary Care Provider-Patient relationship is imperative, but we also recognize that we cannot shift behavior in a matter of weeks; therefore, in 2015, as we launch the gatekeeper product, we will not penalize specialists for the lack of a referral from the PCP (note, referrals are different than prior authorizations). We will be working with patients and providers, to ensure that we provide a smooth transition in the years to come so that our patients can establish a relationship of trust and communication with their primary care physician.