Is there any way to compare plans?
The NCQA provides information on health insurance plans that can be viewed at its website. You can see if a plan is accredited and compare its quality of care and member satisfaction scores with other plans. The NCQA’s website is: www.ncqa.org/tabid/1243/Default.aspx.
You could also look for state-specific reports to find out the rate of complaints for a health plan and the hospitals it uses. Also, you can look for stories about the health plan in various publications, such as magazines and newspapers.
How does a health plan demonstrate quality?
A high-quality health plan promotes effective and efficient care in a timely fashion with no disparity among social economic groups and a satisfactory experience with member services. A health plan should enhance its members’ experiences with its care and services and by promoting effective and efficient care. Members should be assured that they would receive the recommended care for all of their health needs including preventive services and care management for heart disease, diabetes, respiratory conditions, pediatric care, women’s health and behavioral health. The recommended care will lead to improved health and eventually lower costs.
For health plans, quality is a concept that is not limited to the delivery of health care services. Quality goals are focusing on improving population health, enhancing customer experience and managing appropriate medical utilizations and cost containment by applying evidence-based medicine and avoiding unwarranted variations.
What are other quality measures that an employer should look for in a health plan?
You need to investigate how the health plan ensures good medical care. Are doctors’ qualifications reviewed before they are added to the plan’s network? Is the care provided by a health plan’s doctors and hospitals reviewed on a regular basis? Does the health plan review its own services and make the changes needed to correct the problems? How are member complaints handled? Those are all questions that should be asked and answered.
Talking with current members of the plan to learn of their experiences also can be helpful. They may know if the health plan offers specific programs designed to deal with certain conditions. Specifically, a wellness program to promote a healthy workplace would be an important quality from an employer’s perspective.
Sandra McAnallen is the vice president of network and provider relations for UPMC Health Plan. Reach her at (412) 454-8770 or [email protected].
