People in leadership roles for major Midwestern companies seem to have little confidence that the next U.S. president will do much to expand the pool of those with medical insurance. During the Midwest Business Group on Health annual meeting, not one person out of a crowd of 200 thought health benefits would be expanded one year from January 2008. The informal poll came from a group that included consultants, executives and human resource professionals from some of the Midwest's largest employers.
Connecticut Gov. M. Jodi Rell has expressed reservations about a bill that would permit municipalities, nonprofits and small businesses to join the state employee health insurance pool. Rell said she viewed the legislation as "well-intentioned," but possibly harmful to the state employee health system. The bill allows insurers to base rates on the same factors as they would for small employers outside the pool, such as age, gender, group size, location and type of industry.
President Bush plans to give states more flexibility to prove that they have enrolled 95% of poor children from eligible families under the State Children's Health Insurance Program. Hardly any state meets that threshold, and several states have been forced to scale back their plans to expand coverage beyond children from families at twice the poverty level. The new directive will qualify many of the 15 states that may not have met the criteria using data from the Current Population Survey, according to CMS representatives.
Testifying before the House Committee on Oversight and Government Reform, two Bush administration Cabinet members acknowledged gaps in the capability of U.S. hospitals to deal with a mass-casualty terrorist attack or other disaster. They added, however, that a congressional effort to block pending Medicaid cuts will not fix the problem. Homeland Security Secretary Michael Chertoff and Health and Human Services Secretary Michael Leavitt said lawmakers could instead target funds more directly, such as by financing the stockpiling of hospital beds, ventilator units or medicines, if needed.
The city of Birmingham will provide $20 million in incentives for a project to expand Children's Hospital. Hospital officials say the $450 million project is the single largest healthcare expansion in the state, creating as many as 500 hospital jobs. The incentive plan involves rebating some of the occupational taxes generated by the expansion for the next 20 years, up to $20 million. The new hospital should open in about four years, said hospital CEO Mike Warren.
Tarrant County, TX, commissioners have expressed concern over questions raised by a series of Fort Worth Star-Telegram reports about the JPS Health Network. Commissioners were careful to praise the medical and administrative staff of the taxpayer-supported John Peter Smith Hospital, but promised to press the hospital's leadership on finance and patient care issues at a coming meeting. Commissioner Marti VanRavenswaay, who represents southeast Tarrant County, said she has asked mayors in her precinct to invite residents to meet with her to discuss their complaints and concerns regarding JPS.
The University of Pittsburgh Medical Center has announced it lost money during first nine months of fiscal 2008. Net income was a negative $7 million, compared with a gain of $459 million in the same period a year ago. The drop was largely due to turmoil in financial markets and the resulting pressure on UPMC's $3 billion equity and fixed-income investment portfolio. Despite the overall decline, UPMC Chief Financial Officer Robert DeMichiei argued that it was a "very solid performance" for UPMC. DeMichiei pointed to its sizable cash flow, 6 percent growth in admissions at its 20 hospitals, a 12 percent increase in enrollment to its insurance arm, and a 12 percent increase in operating revenue.
A health plan's communication with members is a critical component that directly influences whether the member feels engaged and will impact how a person ranks his or her health insurer.
That was the key finding in the J.D. Power and Associates 2008 National Health Insurance Plan Study. A total of 37,060 members of large commercial plans (excluding Medicare and Medicaid) completed the survey, which measured member satisfaction for 107 health plans. The study tripled the number of health plans in last year's survey. The study found that those who communicated most effectively with members received the highest scores.
"Broadly speaking, those plans that engage their members, they reach out and touch them more frequently, and do it with the best clarity of message and understanding for the member, tend to be ones that score the highest," says David Stefan, executive director, healthcare practices, at J.D Power and Associates.
A consistent issue throughout the health plans—regardless of where they ranked—was communications, which was positioned lower in terms of satisfaction than other factors. Less than half of members surveyed reported that they fully understood their coverage and member services.
The J.D. Power and Associates survey examined seven key factors:
Coverage and benefits
Choice of doctors, hospitals, and pharmacies
Information and communication
Approval processes
Claims processing
Insurance statements
Customer service
Though coverage, benefits, and choice were weighted as the top health plan factors, Stefan says health plans should focus on improving communications because member outreach touches upon every aspect of a plan. That communication can mean an engaged member and better health outcomes.
Stefan says some of the problems with health insurance communication are:
Plan benefits are not adequately relayed to members
Communication is too confusing or includes too much jargon
Members don't receive adequate information about copays and deductibles
Members don't know how to contact customer service
He adds that if a member doesn't understand the health plan's outreach and is not taking proper advantage of the health plan, the person will mostly likely rank the benefit and coverage lower.
"Members who understand how to use their health plans are better able to access preventive services and get the care and services they need," says Stefan.
One communication that members spoke most positively about were reminders via phone or e-mail about preventive services, such as a mammography or prostate examination. Plans that offered those communications received higher scores on communications and overall, says Stefan.
Not only can health plans learn from the J.D. Power and Associates' study, but employers should also take note. Survey participants were asked who they trust most when it comes to advice about how to stay healthy and how to get healthcare. Not surprisingly 70% of those surveyed listed their doctors as No. 1.
One figure that stands out though is the minuscule 2% given to employers. After the stories of corporate greed and the increasing number of businesses that are penalizing employees with poor health habits, this number is not surprising. These issues have created a divide between businesses and their employees. Employees think their businesses only care about the bottom line, rather than the health of their workers.
The survey did find a possible ally to help with that problem though—health plans. As much as 20% of those surveyed in particular plans listed their health plans as the place for their healthcare information. Stefan says members who trusted their health plans were more engaged.
This study, along with the Silverlink Healthcare Behavior Index that I featured last week, is a one-two punch to health plans, and shows that health plans should review their member communications to ensure they are properly educating and engaging members.
These findings also raise questions: How can health plans communicate with their members without overloading them with too much information? Where can health plans find the most benefit? What are the best ways to educate members? What are the barriers to an educated and engaged member?
Please send me your thoughts. I will share health plans' best communication practices in a future column.
