As the national debate on health care reform goes on, consumers are becoming more educated about what they want in a health care provider and network.
Because health care coverage and provider networks directly impact employee satisfaction, it is in the best interest of the employers to listen to what their employees find important to make sure their needs are met.
“If you have a number of employees not happy with the performance of the network for example, their physicians may not be included, or there are not enough providers to choose from in the right locations this could lead to employee dissatisfaction,” says Mike Grodus, associate vice president of network strategy and provider performance with Priority Health. “You want to make sure you’re using the right organization that has the right doctors, proper customer service and quality providers to take care of your employees.”
Smart Business spoke with Grodus about how to find the right network and how doing so can lead to a happier, healthier work force.
What research should be done before choosing a health care network?
You need to make sure the network includes major hospitals, adequate primary care physicians and specialist coverage.
It’s also important to look at the network’s quality performance and how well the plan works with physicians to achieve the best quality. Review the quality rating of the plan as measured by the National Committee for Quality Assurance, which indicates the health plan’s focus and commitment to quality and to having a high-performing network.
Information regarding the network, quality programs, how physicians are measured and a directory of participating providers is usually included on a plan’s Web site. Doing this research is important to help you find the absolute best coverage and health plan that fits your employees. Due diligence will ensure that the health plan’s network of physicians, hospitals and other providers will meet your employees’ needs.
How important is employee feedback, and how can you solicit that feedback?
It’s prudent for a business to know how employees feel about their health care coverage, as this benefit is an important factor to an employee’s overall satisfaction. You need to listen to employee feedback regarding their needs and what they view as important in health care. This can make a difference in your decision on what type of coverage best fits your company.
Depending on your company’s size, an employee survey could help in getting feedback. This should include such questions as, ‘What do you like best about your health care benefits?’ and ‘What is one thing you would change within your health care coverage that you currently dislike?'
The human resources department for larger companies can also help gather input from conversations with employees during the open enrollment period. You have to be careful what you ask, though. You generally know what you’re able to afford, in terms of health care, and any major changes may not be within your limits.
How can you be sure of the quality of providers in your network?
Each health plan has its own process for verifying the qualifications of a provider before he or she is added to a network. A credentialing process ensures that all guidelines required by NCQA are met and includes primary source verification to ensure that the provider is licensed and has no sanctions or exclusions for federal programs. Malpractice history is reviewed and board certification is also validated.
If everything is met, the provider’s information is then presented to the credentialing committee for approval.
Quality ratings, or provider report cards, are also becoming more common. These ratings measure a physician on quality. Ratings are updated annually. Providers are not rated until they have been in the network long enough to gather sufficient data.
Are there benefits to choosing a larger network over a smaller one?
You may have a network that might not be the largest, but it can be even more effective if the plan is fully engaged with physicians who have high quality ratings and scores. Some providers are better at applying managed care principles and are more engaged in a health plan’s programs, while others may not fully engage themselves in the program.
Sometimes it’s an advantage to be selective in which providers are added to a network. But the network can’t be too small, and you still need to have a sufficient number of physicians and geographical coverage to be able to service your employees. You can have a better product with good coverage and fully engaged physicians.
What questions should you ask a health plan about its network when you’re ready to solicit quotes?
Questions should include:
- What is the network’s geographical coverage?
- What is the adequacy and accessibility of network providers for employees?
- What products are offered?
- What is the health plan’s emphasis on quality, provider pricing discounts and employee healthy living programs?
The variety of products available is important as you try to best match health care coverage to your company’s health care needs.
Mike Grodus is associate vice president of network strategy and provider performance for Priority Health. Reach him at (248) 324-2825 or firstname.lastname@example.org.