In the midst of a global medical crisis, employees’ ability to make good use of their health plan is more critical than ever—to them, their family members, and their employers. Some health plans are far more “user friendly” than others, however, and those differences can lead to different outcomes.
“Employees’ expectations of their health plans were already beginning to shift dramatically prior to the novel coronavirus outbreak, and that trend has accelerated since then,” noted Jeanine Maier, Executive Director of Consumer Experience for Kaiser Permanente. “Health plans need to be nimble to keep up,” she added.
What works well and what are talented employees looking for in a health plan? The following standards and features are at the top of their list:
- Top-quality1 medical professionals. In contrast, an outdated fee-for-service plan designed to encourage employees to seek care from the lowest-cost providers does not inspire confidence in the quality of approved medical groups.1
- Integrated and coordinated care. No more dropping the medical ball or missed opportunities caused by a disconnected pool of health care providers.
- Convenience. The ability to interact with health professionals promptly and remotely, 24/7/365.
- Education. Resources that inspire and empower plan members to make informed choices about care options.
- Affordability and predictability. An end to high deductibles, copays and “surprise bills” for specialized services provided by out-of-network medical specialists.
Picking a health plan based on those criteria is key not only to helping keep your employees and their family members healthy during today’s health crisis, but addressing other critical organizational priorities related to the health crisis—such as cutting costs during an economic slump.
Assessing Medical Professionals
How to assess the quality of health professionals? Every health plan that contracts with a PPO will boast about its high standards for inclusion. “Beyond looking at credentials on paper, it’s important to ask how providers’ incentives are structured,” said David Hudnall, Director, Underwriting for Kaiser Permanente.
Medical practices that contract with PPOs generally operate on a fee-for-service model, and so their income is based on the volume of services performed. Also, physicians in those practices often have to devote some of their attention to running their practice profitably.
In contrast, in a fully insured and integrated health plan like Kaiser Permanente with a fixed charge based on the size of the insured group, care providers cannot be successful financially unless they resolve plan members’ health needs efficiently and adhere to the highest standards of evidence-based medical treatment.
While your employees typically aren’t focused on how physicians are paid, they are keenly aware of how much they spend with every doctor visit, the size of their deductible, and the amount of claims paperwork they face.
Integrated Care: A Bold Approach
A health plan built on a foundation of tight integration of care addresses those concerns. Many health conditions require collaborative efforts by multiple providers, whether it be physicians with different medical specialties, or allied health professionals. Their efforts need to be complementary, not overlapping or duplicative. Also, it’s critical for all providers supporting one plan member to know about any other health conditions the member may have, and how they’re being treated.
This requires a comprehensive centralized medical record system that gives providers easy access to data that enables the most effective and efficient care plan. Such a system also facilitates proactive treatment and testing.
For example, in an integrated system, when a plan member calls in about one health concern, the caller could be reminded of a need to address another issue, such as getting a vaccination or routine screening. The result is not only better care, but time saved by avoiding additional office visits and reducing the amount of time not working.
An integrated health plan that saves members’ time comes with a big potential bonus today: The possibility of greater protection from a viral infection by reducing the number of trips to patient-filled medical offices. Here are some pertinent plan features:
- 24/7 telephonic medical advice from RNs backed by MDs.
- Remote video and phone appointments as well as eVisits with providers. For some conditions, remote diagnostic and treatment decisions can be made using cameras and vital statistics gathering systems.2
- Direct linkage from the clinical contact center to a nearby pharmacy for speedy prescription processing when an in-office visit is not needed, allowing the patient to proceed directly to the Pharmacy or to have prescriptions mailed or delivered.
Additional plan features that can benefit members today and under more normal circumstances:
- A clinical contact center for efficient booking of medical appointments, including with specialists, and arranging appointments with different providers back-to-back to facilitate treatment for multiple issues in one trip to a multi-specialty center.
- After-hours urgent care treatment clinics.
- Primary care physicians with immediate access to specialists to facilitate rapid diagnosis and treatment decisions in complex cases, to enable immediate treatment by the attending physician.
- Rapid reporting of test results (e.g. mammography) uploaded to a secure member Internet portal to put patients at ease, or alert them to schedule a prompt follow-up assessment.
Health Education Empowerment
“Understandably, when medical concerns arise, independent-minded people want to do some research on their own before seeking care, no matter how convenient it is to receive that care,” Maier noted. “The key,” she added, “is making it easy for people to get reliable information that links them to available resources.”
An integrated health plan respects members’ intelligence, furnishes its own trustworthy health information and encourages them to use it. This supports member health and discourages unwarranted use of costly health care resources.
When it’s time to seek medical care, cost should not be an impediment. An integrated care system is generally easier on the wallet than the alternative.
“For employers, the effectiveness of an integrated health system’s care delivery also leads to reasonable rates and smoother premium trends,” said Hudnall. “When a plan succeeds in engaging plan members in managing their health and provides them the services they need efficiently, everybody wins,”3 he added.
1 In the National Committee for Quality Assurance (NCQA) 2019–2020 Health Insurance Plan Ratings, Kaiser Permanente of the Mid-Atlantic States’ private health plan is rated 5 out of 5, among the top 1% in the nation, and our Medicare health plan is rated 4.5 out of 5, the highest rating in DC, MD, and VA. The 2019 Commission on Cancer, a program of the American College of Surgeons, granted Three-Year Accreditation with Commendation to the Kaiser Permanente cancer care program. The Mid-Atlantic Permanente Medical Group is the largest medical group in the Washington, DC, and Baltimore areas and exclusively treats Kaiser Permanente members. Permanente doctors are recognized as Top Doctors in Washingtonian magazine (2019), Northern Virginia Magazine (2019), Baltimore magazine (2019), and Washington Consumers’ CHECKBOOK magazine (2018). According to NCQA’s Quality Compass® 2019, we lead DC, MD, and VA in the following categories: colorectal screening, breast cancer screening, childhood immunizations combo 9, cervical cancer screening, and timeliness of prenatal and postpartum care for women. Quality Compass is a registered trademark of the NCQA.
2 Video visits are available to Kaiser Permanente members who have a camera-equipped computer or mobile device and are registered at kp.org. You must be present in Maryland, Virginia, or Washington, DC, for visits with your primary care physician or behavioral health provider. For urgent video visits with an emergency doctor, you may also be present in West Virginia, Florida, North Carolina, or Pennsylvania. For certain medical or mental health conditions. For video visits with a behavioral health provider, appointments can be scheduled for follow-up care.
3 Testimonials, statements, and opinions presented are applicable to the individuals making the statements. The testimonials are representative of each individual’s experience but the exact results and experience will be unique to each individual.