Expert Advice - November 2004

Factors to Consider When

Selecting the Right Health Plan

by Ty Windfeldt

The cost of healthcare benefits rose 11.2 percent in 2004, according to a survey of 3,000 companies conducted between January and May. The figures from the Kaiser Family Foundation and the Health Research and Educational Trust survey mark the fourth straight year of double-digit increases in health-benefit costs.

Large and small businesses alike face complex choices in choosing health coverage for their employees. Making the wrong choice can risk damage to your employees’ health and loyalty, and to your bottom line.

One company I know chose a health plan that promised competitive premium rates, excellent customer service and a large provider network. After a short time with the health plan, however, the company’s benefit administrator began hearing complaints: Employees calling the plan experienced excessive waits on hold before speaking with a call center staff based hundreds of miles away; the provider network did not offer enough choices in primary care physicians and in the specialists that employees needed; physicians’ staffs complained about poor service and late payments from the health plan; and the company’s leadership rarely heard from their account team except at renewal time. Makes the best use of your premium dollar: Does the plan practice sound financial management? This includes regular audits of its operations and financial statements. Does it operate efficiently, by using advanced, automated systems to pay claims and guide the care of its members?

Helps your employees stay healthy: The best health plans cover preventive care, such as flu vaccinations and regular health screenings. They offer programs to help those with asthma, diabetes and other chronic diseases improve their quality of life and avoid hospitalization and other medical expenses that drive up insurance premiums. If any of your employees face serious medical conditions or procedures, you want a plan that guides them to the right care in the right setting.

Makes coverage decisions carefully: Ask the prospective health plan about its process for selecting the treatments, technologies and medications it will cover. Financially responsible plans have a panel of physicians that meets regularly to choose the most proven and reliable innovations for coverage.

Provides great customer service: Look for a health plan that answers 90 percent of customer calls within 30 seconds and answers most calls so quickly that not more than 2 percent of callers hang up after waiting on hold.

Offers real choice in providers: Your employees will want an extensive choice of primary- and specialty-care physicians. They will also want to have confidence that each physician has the credentials and experience to provide the highest quality care. Ask whether a plan can attract and retain physicians by paying most of its claims within 30 days.

Delivers value-added services: The most highly rated health plans offer services such as: a nurse-triage phone support that delivers medical information to callers around the clock; online access to claims status and other benefit information; delivery of information on benefit plans and protected health information via a secure Web site.

Serves your community: Although leading national health plans serve our state, consider a health plan that exists to serve your community. Your healthcare dollar stays near you, rather than flowing to shareholders in other states.

Maintains a reputation for service: Finally, you would do well to seek out a health plan with a reputation for honesty, for listening to members and physicians, responding to their concerns and providing affordable access to care.

With a careful search, you could find this health plan. Your employees will thank you for it.

Ty Windfeldt
Ty Windfeldt is the marketing director for Hometown Health, the health-insurance division of Washoe Medical Center’s integrated health network.