Issue: September 2001 Issue
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.'
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