Health Plans Often Fail To Provide Free Coverage For Women’s Health : Shots – Health News : NPR

Health Plans Often Fail To Provide Free Coverage For Women’s Health : Shots – Health News : NPR.

Take Your Corners – Hospital Health Plan Negotiation Strategies

Hospital managed care teams need to understand their markets are much more expansive than other hospital competition, advises, a senior exec with a company that provides a range of services to providers.

“Essentially, there are three basic ways of dealing with negotiation differences: Continue reading

How One Health Plan Looked to How Disney Does It To Upgrade Its Call Center

When Kim Suarez and her team at Priority Health set out to renovate the insurer’s call center, they looked to Disney as their model.

“We recognize that the world of healthcare is changing rapidly – and dramatically,” said Suarez, VP of Medical Operations and the Consumer Experience  for the Michigan-based health insurance provider.

“It’s no longer enough just to provide great service, we need to deliver a great experience.  That means we need to fundamentally think differently about how we do business,” she said.

And that started with a trip to the Disney Institute for 20 Priority “champions” to experience a hands-on approach to creating strong teams, developing brand loyalty and consistently surpassing consumer expectations.  After the week-long experience, the team  returned to channel their passion into transforming the call center physically – and philosophically.

The team started with a number of challenges, including the need to condense calls centers in four buildings on the Grand Rapids campus into a single, cohesive location.

The nearly 150 employees answered upwards of 5,000 calls each day – or, to look at it the Disney way, provided 5,000 solutions and a great experience in the process.

Suarez  said  a two-day design charette with architects Progressive AE, was held that led them to explore how they worked together,  how they wanted to work together and how the space should be configured to facilitate such a team approach.

The transformation took about six months, Suarez explained,  but when it was finished, Priority’s new call center featured:

  • Interdisciplinary four-person pods that gathered an entire team –from customer care specialists to pharmacy to clinical care managers– in close physical proximity.  The idea, Suarez explained, was to be able to provide a solution to the caller without having to transfer him or her throughout the organization.  “In keeping with Priority’s philosophy, this new approach gave us greater ownership over each call – and ultimately increased customer satisfaction,” she noted.
  • Ergonomic office furniture, including desks that raise and lower with the touch of a button.  West Michigan office makers Haworth and Herman Miller provided the furniture, which also included wall systems and chairs.
  • Organic elements, such as sand, water, leaves, soothing colors and natural woods.  The branding wall, which is prominent when you enter the call center, features photos of Priority Health customers and serves as a backdrop for one of many collaborative spaces on the floor.  Think hip coffee bar, complete with high-top tables and cool chairs encourage conversation.Natural lighting.  The outer office is ringed by windows, providing natural sunlight to  100 percent of all call center employees.
  • Conference rooms utilize clear windows, which provide privacy simultaneously with an open feeling.  Suarez said the result is a tremendous sense of openness throughout the center.
  • Great visibility, greater technology.  Unlike traditional call centers – and indeed, many large office suites – everyone at his/her workspace has tremendous visibility throughout the room.  Central to the action is a call center stat board, which tracks the number of calls waiting, how long they have been waiting and other pertinent details.
  • Calls go from green to yellow to red, depending on how long they have been in the queue.  In lean management principles, the practice is called providing visual cues that all employees can recognize and respond to.
  • Rewards & Recognition.  Equally as prominent to the entire call center is the new Reward & Recognition board, which prominently displays compliments that employees receive from customers.  Suarez said Priority adapted the concept from Zingerman’s, which uses similar “code green” to share good news.
  • Business continuity planning.  Priority Health also invested in laptops and IP headsets in the event that call center operations are disrupted and employees need to work from home or another remote location.

“We have had tremendous response from our employees and our customers over the new call center,” Suarez said.

“But we did diverge from Disney philosophy on one key point:  Disney invests all of its funds for ‘on-stage’ areas, meaning that had an incredibly unattractive call center. ”

Even though Priority’s call center is “back stage,” it is really the backbone of our operation, Suarez observed.  “We invested significantly to create one of the most attractive and functional spaces as our call center – and it shows.”

Source: Priority Health

Are MCOs adequately addressing member satisfaction needs?

Related to the member communication initiatives of MCOs is meeting member\patient satisfaction.

So are health plans addressing patient satisfaction as a top priority?

This is question, from our Managed Care Leadership Survey, stirs strong opinions from providers, payers and others.

For instance: “No. Major carriers are doing just enough to maintain their satisfaction levels. They are also building their own satisfaction surveys to give the impression that they are top notch. A better way would to use a consistent measure like CAHPS to monitor.”

“Yes. New rules and bonus payments”

“No. Too little in the way of real tools, peer to peer assistance”

“No. Growing limits on provider access and increased carveouts are creating growing member dissatisfaction.”

“Yes. Adequately, yes. Meeting expectations, probably not. All depends on the benchmarks one is willing to use to measure member satisfaction.”

Source: Managed Care Information Center

Inside Report: IPAs – PHOs Definitely Worth Another Look

Independent practice associations (IPAs) and physician hospital organizations (PHOs) have risen to a prime position in the healthcare provider market, especially in recent months.

Imagine physician organizations were written off for dead just a few years ago. Impatient for successful results, hospitals and physicians were shutting down their PHO partnerships.

The smaller IPAs just faded away – just another healthcare ‘gimmick.’ A failed idea.

So the overall numbers of physician organizations has shrunk in terms of numbers of organizations, according to our research results for the National Directory of Physician Organizations Database, produced by the Managed Care Information Center.

But the PHOs and IPAs with sharp leadership stuck with it. And, today they are stronger and importantly positioned to be significant players in today’s changing provider arena.

First the major IPAs across the country proved that they were indeed viable. Led by sharp executives and leadership, patients and health plans and their members came.

“If you build it they will come.”

After a few battles with the federal trade commission physician organizations got the FTC’s green light for clinical integration initiatives.

The exploding wave of pay-for-performance programs reinforced that IPA and PHO member physicians could ramp up their quality of care measures and patient satisfaction numbers.

Because of the success of IPAs, there has also been a wave of consolidation further strengthening their position in the marketplace.

Health and managed care executives have told us about what’s shaping today’s market.

“Health Reform…it is changing the entire playing field; Significant changes in the relationships between payors, providers and patients due to health reform; tiered networks that exclude academic medical centers; Continuing movement from government and payors to P4P programs (heavy emphasis on quality); and, P4P will be easier for large carriers to implement than any real payment reform,” were among just a few of the observations shared by participants in the Managed Care Leadership Survey.

Now, even as rules governing accountable care organizations have just been proposed by the Centers for Medicare and Medicaid Services (CMS) physician organizations in several sections of the country have been out-of-the-gate first.

Physician organizations now have as physician members a major number of the practicing primary care and specialist physicians in the country.

And, as they continue to bulk up, physician organizations are having to upgrade their infrastructure, IT systems, and processes.

A rising tide does indeed float all boats; at least the IPA and PHO crafts.

Bob Jenkins

Bob Jenkins is the CEO of the Managed Care Information Center.

Research source: The National Directory of Physician Organizations Database

Copyright 2011, The Managed Care Information Center, 1913 Atlantic Avenue, Ste 200, Manasquan, NJ 08736  (800) 516-4343