Looking to get your health plan costs under control? Here’s where to start.
In a difficult economic environment, the challenge of managing health plan costs becomes an even more urgent priority than during ordinary times. And traditional tactics, like arm-wrestling your plan provider and shifting more of the financial burden to employees, are not a viable solution.
“A more successful long-term strategy,1” said David Hudnall, Director, Underwriting for Kaiser Permanente, “involves partnering with an integrated health plan that looks at care from a holistic perspective.” That’s a plan that:
- Shares financial risk with you, thereby giving itself the incentive to use expensive resources—people and equipment—effectively,
- Fully exploits the latest information technology to maximize operational efficiency,
- Inspires and equips employees to take charge of their health,
- Minimizes employees’ obtaining health care services during work hours.
How does all of that look in real life?
Sharing Financial Risk
To share financial risk, it helps to partner with a fully insured health plan that sets a fixed per-employee charge for comprehensive coverage. That’s in stark contrast to traditional fee-for-service-based insurance system plans featuring high deductibles and PPO networks. “With them,” Hudnall said, “much more of the risk falls on the shoulders of employers and their employees.”
How can a fully integrated health plan afford to take on greater financial risk without becoming more expensive than traditional plans? By combining a tightly integrated care delivery system with a fully insured design, a health plan can:
- Deliver an excellent employee/member experience,
- Guide members towards more effective utilization health care resources, and
- Produce better outcomes at a competitive cost.
The health care professionals who work in such systems have only one job: patient care. In that way they are unlike many independent physicians in preferred provider networks who also have a professional practice enterprise to run.
“Taking care of patients and keeping them healthy from the start, especially in a public health crisis like today’s, is the reason most doctors go into medicine,” said Jeanine Maier, Kaiser Permanente’s Executive Director of Consumer Experience. “That’s how we’re able to attract top professionals.2”
In an integrated system, physicians and other health professionals are usually working safely together under one roof. That facilitates efficient interaction, often in real time, to marshal the resources needed to address health issues promptly. This capability often leads to better results and greater patient satisfaction.
Empowering Your Employees
Also, a consolidated strategy to keep people healthy and costs under control includes prompting members to assume greater responsibility for their own care. Providing compelling and easily accessible educational content and personal health data can support that shift. Resources and information need to be pertinent to each employee and family member.
Providing prompt electronic access to their medical records and test results is part of the solution. So is giving members practical and actionable insights about what the data means. All of this works best when members are prompted to access the information when a member is addressing (or needs to address) a particular health issue.
Equally critical is members’ ability to conveniently interact with appropriate medical professionals promptly, before their health concerns become more serious—and costly. One member’s idea of convenience may differ from that of another. Therefore, the more forms of interaction available to members, the better. Kaiser Permanente members, for example, can send a secure message, seek advice using a telephone, and engage in a virtual visit from a secure platform.3
Keeping Employees Working
Interaction with providers often can occur without plan members needing to take leave from work, thanks to virtual visit capabilities. A virtual visit may consume as little as 20 minutes (or less) of an employee’s time, versus two hours or more when a drive to a medical facility is required.
A 24/7 assessment and advice call center can handle many health concerns. When the issues are more serious, plan physicians have instant access to patient health data, possibly including current vital statistics that can be captured remotely. That makes video and phone-based medical appointments possible. This mode of treatment is particularly useful in limiting the risk of exposure to a harmful virus during a viral pandemic.
Also, it’s easy to forget routine preventive steps people need to take to stay healthy. An integrated health plan helps them stay on track when they contact their health center, for example to schedule an appointment. The member liaison who receives the call can quickly scan the member’s file for other pending health matters. That means, for example, that a member coming to a health center for a dermatology appointment can be guided to get a flu shot on the same visit.
Supporting Employers Like You
The same information technology infrastructure that enables efficient, data-rich communication among health care providers and plan members, also makes life easier for employers. Consistent with regulatory requirements, employers can access data that yields insights on the health status and needs of their employee populations.
On the administrative side, “nothing falls through the cracks when transitioning from another carrier to our system1,” Hudnall said. A well-designed integrated health plan’s data interface enables easy communication between an employer’s HR system and the health plan’s for employee census updates, billing, and related matters.
In principle, a health plan featuring integrated care delivered by highly qualified providers4, the balancing of financial risk between employers and the health plan, and world class information systems, can keep costs under control. History offers a better guide than theory, however.
A health plan that you’re reviewing should provide historical data on its rate trend, caps on annual rate adjustments, and discuss its collaboration with demographically comparable employers to optimize their plan features.
1 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.
2 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).
3 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.
4 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.