Satisfying your customers' and members' needs could be the difference between succeeding in these belt-tightening times or watching your employer market evaporate. It will take more than a flashy marketing campaign to win over employers who are focused on the bottom line and reducing contracts.
Employers want simplicity—and that means bringing services such as disease management, wellness, pharmacy benefit management, and dental in-house. This one-stop solution is a way health plans can set themselves apart from the competition, allowing employers to deal with fewer health companies, and reducing member confusion.
Coordinating services was why Capital BlueCross in Harrisburg, PA, recently bought Dominion Dental Services, a privately held corporation with 400,000 members that is based in Alexandria, VA. Capital offers health benefits to nearly one million people in 21 counties in central Pennsylvania and the Lehigh Valley and is one of four Blues operating in the Keystone State. Once the sale is finalized, Capital will become the only Blue-branded dental plan in central Pennsylvania. Dominion will provide the back office work for BlueCross Dental, such as processing claims, while Capital will brand the dental program with its marketing. (Dominion will continue to provide services to its Mid-Atlantic members in Maryland, Delaware, Virginia, and Washington, DC.)
Sandra Neydl, manager of product implementation for Capital BlueCross, says the purchase of Dominion broadens Capital's portfolio as well as offers administration simplicities and efficiencies to its customers.
Why would a health insurer want to get involved in dental insurance?
Robert Zirkelbach, director of strategic communications at America's Health Insurance Plans, says customers are increasingly demanding dental coverage and health insurers see a connection between oral health and other conditions, including diabetes and cardiovascular disease, he says. There are two others reasons:
Dental insurance gives health insurers a more predictable offering and lower risk than medical. Dieter Freer, divisional senior vice president for local and consumer markets at Blue Cross and Blue Shield of Illinois in Chicago, says the most costly dental procedure palls in comparison to costs associated with normal medical procedures and hospitalizations. Plus, many health plans have a fairly low cap on dental benefits.
Bringing dental services in-house allows insurers to have a more rounded view of their individual members. Freer says BCBS of IL integrated medical and dental data in January, which allows the insurer to take a more holistic approach to its members. Through this integrated system, BCBS of IL is able to reach out to members who are at-risk of conditions that could be complicated by dental diseases. The insurer can contact those members and make sure they are getting treatment in the right setting before health issues arise. This leads to better quality of life for its members, he adds.
There is an initial downside. Health plans that offer dental coverage will need to hire new staff with a dental background. "If you are going to be successful in the dental business, you are going to need an entire group of individuals focused solely on dental benefits," says Freer of BCBS of IL, which began offering dental benefits in 1975 and now provides dental PPOs and HMOs to more than one million members.
Adding dental is particularly important for Capital. Two Blues plans in Pennsylvania, Independence Blue Cross and Highmark, have proposed a merger that would create a giant health plan that would stretch across most of the state. The state is expected to decide on the merger in the first quarter of 2009.
Neydl says the Dominion purchase is not in response to the proposed merger. Regardless of the reason, dental does make Capital a more appealing option for potential customers and a way to compete against larger health plans.
Streamlining processes and communications for employers is a way to stay competitive in a shrinking employer market. As health plans forge ahead in a rough economy, they should explore moving services in-house. Bringing in dental coverage in-house will mean adding staff, but dental will produce a steady stream of money and allow your company to have a more rounded view of members.
Les Masterson is senior editor of Health Plan Insider. He can be reached at lmasterson@healthleadersmedia.com.Note: You can sign up to receiveHealth Plan Insider, a free weekly e-newsletter designed to bring breaking news and analysis of important developments at health plans and other managed care organizations to your inbox.
HCA Inc. is closing the emergency department and most other operations at its 38-bed hospital in Portland, TN, a decision that affects about 60 employees. In addition, HCA subsidiary TriStar Health System is planning to cut 50 administrative and management jobs in 2009, including through not filling open positions and changing the roles of some employees.
Employees at Ohio-based MetroHealth System have found out that their numbers will be reduced by 112 to break even financially next year. The job eliminations are primarily in unfilled positions, but about 25 employees will be laid off effective the first of December. The layoffs and job eliminations are expected to save the hospital about $6 million in 2009.
Changes to the healthcare workforce, patient demographics, and payment structures will alter the fundamental building blocks of healthcare delivery—shifting it from hospital to ambulatory settings—by 2020, according to a new report authored by healthcare-intelligence company Sg2.
"The era of the primacy of hospital is starting to fade into background," says Bill Woodson, Sg2 senior vice president. "We currently have a healthcare system that is very focused on sustaining inpatient facilities. In the future, the health system will be defined by physician practice and ambulatory presence, and by how it makes connections for patients across the continuum of care."
That change will be driven, in part, by a "payment landscape that would look frightening and challenging to the hospital CEO of today," Woodson adds.
Hospitals that reposition to succeed in the new environment—through alignment with physicians, performance improvements, and IT infrastructure—will be part of a dynamic system of care with multiple patient touch points, the report concludes.
One of the biggest challenges, however, may be workforce development. High demand caused by an aging population coupled with shortages across almost every provider category will be difficult to overcome and will require "doing more with less," the report says.
Midlevel providers will offer a broader level of care, which will help improve primary care physician productivity. Advances in technology will drive further subspecialization among other physicians.
Hospital leaders should begin preparing for the new healthcare landscape now, Woodson says.
"There’s some urgency around this 2020 thinking, because it ties in with the economic story that’s unfolding right now. Our members are surprised at how much the market has turned on them in the last six months and all of the sudden they’re dealing with a more challenging budget situation," he says. "This is the perfect time to change your approach to managing your resources and thinking about the future."
A federal appeals court in Boston has dealt a setback to the pharmaceutical industry and companies that collect prescription data for use in drug marketing. The court upheld the right of states to prohibit the sale of doctor-specific prescription drug data that is widely used in pharmaceutical marketing. IMS Health and Verispan sued to block implementation of a New Hampshire law which prohibited the sale of computerized data showing which doctors were prescribing what drugs.
A judge has dismissed charges against a Filipino doctor accused of defrauding the U.S. military's healthcare program by submitting $2 million worth of bogus claims, saying prosecutors waited too long to arrest him after filing charges. U.S. District Judge Barbara Crabb ruled that Diogenes Dionisio, MD's constitutional right to a speedy trial was violated because investigators waited four years to arrest him after his 2004 indictment.