“Targeted Gatekeeper Model” for Specialist Referrals Gains Momentum Under Accountable Care and Value-Based Reimbursement

February 17, 2017
Targeted Healthcare

“Targeted Gatekeeper Model” for Specialist Referrals Gains Momentum Under Accountable Care and Value-Based Reimbursement

SAN MATEO, Calif.–(BUSINESS WIRE)–In the 1980s and 1990s, health plans and other payers depended on primary care physicians (“PCPs”) to be the gatekeeper for referrals to specialists. Covered members were required to select a gatekeeper in order to receive medical coverage. This gatekeeper model was not successful for several reasons. “Research studies showed that gatekeeper models generally were no more efficient at curtailing medical trend than non-gatekeeper plan designs. Also, large employers wanted more open access to specialist care for their employees,” stated Dr. Douglas G. Cave, President of Cave Consulting Group (“CCGroup”).

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