Many employers have turned to managed care as a cost effective means of providing quality health care for their employees. The most challenging task often is the process of selecting the best health plan to meet the needs of employees and your company.
This process can be time intensive and involve everything from comparing prices and coverage to lengthy meetings with managed care organizations, as well as discussions with colleagues to gain insight into how they’ve handled similar situations.
Once the comparison shopping is completed and the MCO has been selected, it is equally important for small business owners to stay involved and work with their MCO to ensure employees use the plan wisely and properly. When employees complain about their health plans, it’s often because it’s misunderstood.
When working with an MCO, there may be unfamiliar rules and guidelines that should be followed. The tradeoff, however, is that an MCO can often save you money.
With that in mind, the following are steps that an employer can take to help employees and hospitals work with the MCO to obtain all the health care they need and deserve.
- Turn in all necessary paperwork in a timely fashion. While this sounds basic, there are times when delays in providing the applications and related materials hold up the processing of information by the MCO. This can result in a lag time in coverage and create undue anxiety and hardship for employees.
- Allow the MCO to hold an informational meeting with your employees at the start of coverage. The meeting should be mandatory. Education about the plan is the best way to ensure compliance with procedures and assure coverage for employees.
- After coverage has begun, schedule meetings at mid-year between the MCO and employees. This provides a forum for employees to ask specific questions, discuss their experiences and raise particular issues. The MCO has an opportunity to provide updates on the plan and offer strategies for working with the plan.
- Encourage employees to contact the MCO’s customer service department directly to discuss procedure and ask questions. Many times, employers will call with questions or issues on behalf of workers. By encouraging employees to communicate directly with the MCO, employers will help educate their workers in the proper use of the plan. The MCO can often give employees assistance in obtaining the right coverage.
- Take advantage of communications that are often provided by MCOs. These include newsletters or payroll notices that discuss issues, ranging from tips for selecting a primary car physician to explanations on how to obtain referrals to specialists. Posting communications on bulletin boards helps with the education process, also.
- Encourage employees who have chosen new primary care physicians to establish a relationship with their doctors as a soon as possible. Suggest they schedule an appointment for an annual exam within the first month of coverage. This will not only allow employees to receive good, preventative care, but also provide a chance to familiarize themselves with their new position. Employees should read their plan literature so they know how to use the plan before a problem or emergency arises.
- Provide opportunities to employees to share any concerns or issues with you on an ongoing basis. As the employer, you can share them with the MCO to prevent possible problems.
William C. Epling is the chief operating officer of HomeTown Health Network in Massillon and Akron and the chairman of the Ohio Association of Health Plans Board of trustees.