For those who remember the health maintenance organizations of the 1980s and 1990s, a return to the primary care doctor as gatekeeper to specialists may not appeal at first glance.

But St. Elizabeth Healthcare, in conjunction with Humana, has built a case for the change that begins with a big cost savings to customers and insurers that is designed to end with effective care and fewer unnecessary procedures. Among the changes since the 1980s are computerized records and the end of paper charts.

Called the TotalCare Plan HMO, the model was offered for the first time to St. Elizabeth Healthcare employees beginning in January. A worker with a spouse and two children who opts for the plan will save $900 this year. The tradeoff is a requirement to use specialists and facilities within the St. Elizabeth network, and only after authorization from their primary care doctors.

There are a few exceptions to the in-network rule, including authorized use of Cincinnati Children’s Hospital Medical Center, Bethesda North for women’s reproductive services not offered at St. Elizabeth, and very specialized care that the network does not offer. But elective care outside of the network — a mother who wants to deliver her baby at Christ Hospital, for example — is not covered.

William Banks, St. Elizabeth vice president of managed care, created the new plan with Humana officials. He says the plan was designed to reduce the cost of health care by 10 percent this year. Through September, TotalCare was exceeding that cost savings, he says.

He says the savings are not coming at the expense of quality care but instead are the result of smarter decisions.

Banks cites the example of a 45-year-old male runner with sore knees. Under the former plan, he may have been more likely go straight to a highly-regarded orthopedic surgeon who probably owns an MRI machine and may have his own operating facilities. In that scenario, Banks says, the chances may have been greater that the surgeon would order an MRI at minimum and maybe recommend knee replacement.

The primary doctor is more likely to instead prescribe physical therapy, better stretching and other less costly but effective treatments.

In cases of less healthy patients — for example, an overweight man in his late 50s with diabetes, emerging heart disease and other problems — having a primary care doctor sign off on visits to cardiologists and other specialists should improve coordination of care and ensure that prescriptions from various doctors work in tandem and do not possibly counteract one another.

The system works more efficiently than its 20th Century counterpart thanks to the emergence of electronic recordkeeping, which ensures everyone within the system has access to the same information.

Tim Cappel, president of Humana of Ohio and Northern Kentucky, explains in a release the benefits of the plan: “By working closely with St. Elizabeth Healthcare, we were able to create a plan that delivers immediate savings. Plus, we believe members will see compounded savings over time because of St. Elizabeth Healthcare’s ability to deliver integrated, efficient care that maintains health.”

Banks expects more St. Elizabeth employees to opt into the system in 2012, and TotalCare is picking up new clients, including Northern Kentucky University and Little Red School House preschools.

“It’s working great. What I can tell you is the initial data is showing great things,” Banks says.