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Oxford Health Plan’s new specialty-team approach is based on the assumption that direct access to specialists doesn’t have to break the bank if you have the right provider team in place (see related story on p. 64). The following example illustrates how one patient might move through the Norwalk, CT-based health plan’s system under the specialty care approach:
Jack, a healthy 45-year-old with no major health care problems, is an excellent runner but slips on ice and tears a knee ligament. As a result, he needs to have knee surgery. Jack chooses an orthopedic specialty care team by comparing the credentials of team members and volume of similar sports injury cases that the team has managed. The first step is a trip to the specialist who determines the treatment options. In Jack’s case, this likely includes a trip to the radiologist for X-rays.
The team completes the necessary tests and paperwork, and schedules Jack’s outpatient surgery at an outpatient surgery center. The specialty team completes the surgery. After surgery, Jack is given several weeks of follow-up physical therapy by the team’s specialists in this area.
As a final step in the process, Oxford and the specialty team assess the case’s outcome (based on predetermined criteria) and Jack’s satisfaction with the care he received.