jogojitsurma: Choosing a Health Insurance Provider

by Lisa Slattery

In today?s economy, it?s natural for employers to compare health insurance options based on premiums alone.? Unfortunately, if benefits, network, customer service and quality ratings are not considered, the result can be poor overall value, frustrated employees, increased future medical costs and increased absenteeism.

Oftentimes, large insurance companies work on a cyclical pricing trend, offering very low premiums the first year that are typically unsustainable over the following 2-3 years.? Employers are best served by seeking overall consistency in value, which for most customers means high quality and accessible healthcare for a reasonable price over time.? They should expect their insurance company to not only pay claims accurately and quickly, but also support them in keeping their employees in the best health possible in order to reduce lost work days and increase productivity.

Some of the challenges we hear from employers that return to us after trying a different company include trouble accessing ?a live person to answer my questions or resolve any issues,? lack of access to desired providers, lack of support for members going through difficult health challenges, and quality and customer service issues that lead to increased frustration, poorer outcomes, and less healthy employees.

Defining Quality

1. For Employers: Business owners hold themselves to the highest standards, and should expect no less from their health insurance partner.? A high quality health insurance company holds itself up to National Committee for Quality Assurance (NCQA) standards, which are the most stringent in the industry.? The reason for doing so is that NCQA measures the health outcomes of the members enrolled in health plans, and regularly evaluates network access, availability of preventive care and wellness, customer satisfaction with providers as well as with the insurance company, and consistency in managing chronic illness.? Look for a plan that has an NCQA accreditation rating of ?Excellent,? the highest possible rating.

2. For Employees: The average employee sees health insurance as a necessity, albeit one they hope not to have to use very often.? Quality for most employees involves easy and affordable access to good doctors who help them stay well and treat minor illnesses.? Gym memberships, for example, help improve the overall health and well-being of an individual.

For employees who experience an unexpected illness or injury, or those living with a chronic disease, the last thing they want to do is hassle with issues surrounding their health coverage.? So from this perspective, high quality means quick and accurate payment of covered services, clear communication concerning what isn?t covered, and the ability to talk with a friendly, knowledgeable person when questions arise.? Access to a certified Nurse Case Manager is a huge employee satisfier when they are trying to navigate the complex world of health care.

Choosing an Insurance Provider

For the last several years, Health First Health Plans (HFHP) has been rated the second highest health plan in the State of Florida by the National Committee for Quality Assurance ? Health Insurance Plan Rankings.

The Centers for Medicare and Medicaid (CMS) utilizes a STAR rating program to allow consumers to compare plans based on quality and customer service.? There are currently no 5 STAR plans in the State of Florida, however HFHP is one of only five Medicare Advantage plans ? and the only option in Brevard and Indian River counties ? rated 4.5 STARS.? In addition, HFHP is in the top 10 percent of Medicare Advantage plans in the country, as ranked by NCQA, and our commercial plans are in the top quartile in the nation.

For the majority of employers, the key to understanding the STARS and other national ratings is this ? from the inception of Health First Health Plans, there has been a firm commitment to create a health plan that was different, with a strong commitment to our members, and close partnership with our providers.? By placing the member at the heart of all of our business decisions, we are able to rank as a top national plan in both Medicare and commercial lines of business.? We measure the same health outcomes and customer satisfaction for all of our members, so we are able to consistently rate highly when new measures of quality and service are released.

Quality Healthcare = Happy Employees

A recent study conducted by UNUM Group Corporation found that 82 percent of employees surveyed who rated their health benefits highly, also rated their employer an excellent or good place to work.? We all know that when employees are satisfied at work they are more productive, so consider all your options and choose carefully when evaluating health insurance coverage for your valued staff.

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Lisa Slattery is Senior Vice President of Quality Management/Chief Quality Officer for Health First Health Plans.