Care Packages

Area experts provide advice and tips for your health-care needs.

Q: How are health-care providers using the Internet to better connect with and serve the needs of their clients?

A: 'As a health-care management company, CorVel uses the Internet in conjunction with its own technology to help coordinate and consolidate claims-management activities online,' says George C. Smith III, CorVel Health Care Corp.'s vice president of operations. 'This allows health-care professionals to review comprehensive case information and communicate instantly to collaborate on claims without delay or paperwork. We have a lot of providers who come to us with questions; usually they're waiting for paperwork to go back and forth. In the future, you're going to see the capability of an entire e-commerce universe — from the claim to the bill to the electronic-fund transfer. For you, as a provider, it will be totally paperless.'

Q: What should a company look for when choosing a managed-care provider that not only meets its employees' needs, but also helps to control health-care costs?

A: 'Companies should take a look at the quality of physicians and the quality of institutions that are available through the plan's network,' says John Amantea, director of communications for QualChoice Health Plan. 'For example, since there are so many working mothers in the work force now, a company might want to pay attention to a plan that offers access to the physicians and facilities who specialize in women's health. The employer has to have a pretty good understanding of the kind of medical care that is going to be needed by the work force. Convenience is also a big deal. It is good to know that people who are processing your claims and answering your phone calls are here in Cleveland.'

Q: When is the right time to seek the assistance of an insurance broker?

A: 'The earlier the better,' says Mica F. Bane, senior vice president and director of transactional benefits at Acordia. 'It's much easier to get our arms around the risk-management and risk-evaluation process with ample time to evaluate the situation and the needs of a client. That could be anywhere from six months to a year, depending on client size, multistate locations, number of plans offered, bargaining agreements. These all impact the timing and the issues that are involved in a client with health and welfare consulting.'

Q: What types of preventative programs are managed-care providers making available to keep clients healthy?

A: 'We encourage annual visits or physicals with clients' primary care physicians so that we can identify those issues that can be dealt with in preventative care,' says Marty Hauser, president of SummaCare Health Plan. 'Managed-care programs focus heavily on preventative care under the theory that if you can keep people healthy, they'll stay healthy and health-care costs will be reduced. On the other side, once determined that someone has a condition — such as a pregnancy or congestive heart failure — there are case-management programs that coordinate with physicians to make sure the patient is getting the care they need, and that they're keeping appointments and taking their medication daily.'

Q: Why are some health plans abandoning or de-emphasizing small employer and individual health plans?

A: 'There are several reasons why this is occurring. Some large plans are spread too thin, resulting in poor service and noncompetitive premium rates,' says Steven Puck, chief marketing officer and senior vice president at Renaissance Health Plan. 'Still other plans believe the larger groups to be more profitable. This creates a need and an opportunity in these marketplaces, requiring a successful health plan to be focused with products and expertise tailored to the locale and consumer needs.'

Q: When should a company re-evaluate its health-care needs?

A: 'Companies need to assess whether the product is meeting the needs of their current employees on an annual basis,' says Scott Lyon, COSE's executive director of Group Services Inc. 'When you get the renewal packet from your current insurance carrier — which is almost on an annual basis nowadays — you should do a couple of things. One, review the products offered to make sure the health-insurance plan meets the employees' needs. Secondly, review the cost-sharing agreement between employer and employee. A recent survey indicates that 63 percent of COSE members pay the premium in full, and that 44 percent pay the entire premium for dependents. Depending on how steep the increase in insurance is from the provider, you're going to need to review the cost-sharing agreement.'

Q: Is there any magic formula or golden rule for companies to follow when dealing with health-care expenses?

A: 'I don't think that there is a magic formula,' says Joan Mason, president of Ohio Health Choice. 'It's a unique challenge for each employer to find a balance of access, quality and cost to fulfill its employees' health-care needs. Employers should work with players to customize health care and to find a solution that fits their unique population and set of needs.'