Health Plan Member Satisfaction in 2014

Issues surrounding the time a member must wait after a pre-approval request has been submitted to their health plan before they hear from their provider, to concerns about having adequate health coverage, and health plan notices of changes in their coverage, networks or rates are having an impact on members satisfaction with their plan, found a recent study.

Some 41 percent of existing health plan members believe that they lack enough coverage for routine visits, serious illness or injury, health and wellness programs, routine diagnostics and drug coverage, found the study by market research firm J.D. Power.

Concerns over not having enough health coverage negatively impacts overall satisfaction by 133 points, more than any other coverage-related issue, according to the J.D. Power 2014 Member Health Plan StudySM.

The study, in its eight year, measures satisfaction among members of 136 health plans in 18 regions throughout the United States by examining six key factors: coverage and benefits; provider choice; information and communication; claims processing; cost; and customer service.

The National Directory of Managed Care
Organizations Database for Your State

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In 2014, overall member satisfaction averages 669 (on a 1,000-point scale), the firm said.

Key Findings include:   Continue reading

News Release – 2014 National Directory of Managed Care Organizations Database Produced

News Release

For Immediate Release

New Edition of Database Provides Overview, Details and Managed Care Market Key Decision Makers

Phone: 1- 800-516-4343

ALLENWOOD, NJ – The 2014 edition of the National Directory of Managed Care Organizations has been published by the Managed Care Information Center.

As in other industries – there has been consolidation in the managed care organization arena as well, Managed Care Information research has found.

Research on the 2014 edition of the National Directory of Manaaged Care Organizatyions project results reflects the various health plan consolidations – mergers and acquisitions.

The unique database provides market intelligence information on more than 1180 managed care organizations representing 5,279 health insurance plans.

The new edition includes listings of all managed care companies including health maintenance organizations (HMOs), preferred provider organizations (PPOs), consumer driven health plans (CDHPs), health savings accounts (HSAs), point-of-service plans (POS), and several other types of managed care organizations.

The directory database also covers specialty HMOs and PPOs, and includes details on TPAs, POSs, EPOs, Medicare and Medicaid health insurance plans, and Medicare Advantage Health plans and Medicare Part D prescription plans.

The directory is known for providing more “need to know” detail in the managed care organization profiles presented.

Organization profiles include the health insurance companies’ main address, phone, fax, and key executive officers.

To help users ‘size’ a market, the directory includes the number of primary care physicians and specialist physicians in the managed care company network; and the number of hospitals with which the health plan has contracts.

The database includes such key contact names as CEO, CFO, COO, medical director, and CIO. The name of the parent organization, the year the organization was founded, and web site address also is provided.

The National Directory of Managed Organizations Database with user’s manual and instructions is delivered on CD-Rom.

For more information contact The Managed Care Information Center – Health Resources Online  toll-free telephone 1-800-516-4343, email:

Or click on this link: National Directory of Managed Care Organizations Database

Address: The Managed Care Information Center, PO Box 456, Allenwood, NJ 08720

Contact: 1-800-516-4343

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The 2014 edition of the National Directory of Managed Care Organizations Database is Now Available

The 2014 edition of the National Directory of Managed Care Organizations Database is now available.

We have completed a full, thorough update and verification of the database. So it is ‘squeaky clean.’

For ‘bragging’ rights we want you to know that our work is extremely detailed. We especially zeroed in on C-Suite and other senior health plan executives.

Results: 12,282 changes to the database.

There has been – as in other industries – consolidation in the managed care organization arena as well, our research has found.

The research project results reflects the various health plan consolidations – mergers and acquisitions.

The National Directory of Managed Care Organizations Database has been continually researched, verified and compiled by the Managed Care Information Center team since 1996.

The database includes hard-to-find managed care information on HMOs, PPOs, POSs, Specialty MCOs,  health plans that offer consumer driven health plans (CDHPs) and health savings accounts (HSAs) , Medicare Advantage plans, Medicaid Managed Care plans,and Medicare Part D prescription plans.

For details on the new edition of this trusted database visit:


Managed Care Information Center ‘Store’ New Web Address

Our health and managed care databases
store page has a new web address following
our migration to our new,improved web site

The store is protected for security with “Secure Socket Layer” or SSL to keep your transactions secure.

Because there are so many links to our directory – databases and management resources up on the Web we think it is a good idea to give you the new location link:

Selling to Managed Care Organizations? Share Your Insight

For sales, marketing and business development directors, if your market includes health payers, take moment to participate in this very brief Managed Care Organization Vendor Sales Insight Leaders’ Survey from the Managed Care Information Center.

We are confident that the results will be of keen interest.

Your participation will only take a moment to answer two short questions. We will share the results with those who respond to the survey.

Please click on this link now: Managed Care Organization Vendor Sales Insight Leaders’ Survey

Putting the Finishing Touches to our National Directory of Managed Care Organizations

There are a handful of records left to complete in our re-verification and update research project for the National directory of Managed Care Organizations Database.

Already there have been more than 7,000 changes found and edited. Once we get through the entire file, then we go back over the company records that we had questions on.

Consolidation is continuing in the managed care organization market, we are finding.

Our research has found companies no longer exist or they have been acquired by other health insurers.

Among the acquirers are UnitedHealth Group and Aetna.

The database includes listings of health maintenance organizations (HMOs), preferred provider organizations (PPOs), Consumer Driven Health Plans (CDHP), Health Savings Accounts (HSAs), point-of-service plans (POS), and several other types of managed care organizations.

The database alsoincludes specialty HMOs and PPOs, and includes details on PBMs, URs, TPAs, PSOs, POSs, EPOs, Medicare and Medicaid Plans, Medicare Part D plans.

For descriptive information on the database, please click on this link now:  The National Directory of Managed Care Organizations 2013

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

Bundled Payments May Be Another Developing Trend to Watch: Anthem Adopts Bundled Payment Agreements For Two Providers

Anthem BCBS has entered into “bundled payment” arrangements for select surgical procedures at the Orthopedic & Sports Institute of the Fox Valley in Appleton, Wis. and at Manitowoc Surgery Center in Manitowoc, Wis.

A “bundled payment” groups and coordinates all of the charges associated with a surgery and recovery together for one pre-negotiated price. This means an individual can quickly and easily understand their potential out-of-pocket costs before surgery and results in greatly reduced paperwork for all involved.

“Think of a bundled payment like a restaurant offering a complete meal for $20 deal,” said John Foley, regional 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

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