Wellness Programs : Medical Insurance Business Accountability.
Are your health care programs delivering on your vendors’ promises?
Just as importantly, how can you hold providers accountable if you’re not getting what you paid for?
Here’s one proven way – Develop a provider scorecard. Scorecards alone won’t bring down your health care costs. But they’ll at least help be sure your organization – and staff – get everything you’re compensating for.
The tool can help you measure plan performance with greater precision – and identify specific areas that need improvement. Best of all, any corporation can adopt the technique to fit their needs. Here’s how it works.
1. Pick specific rating areas
Benefit pros who’ve successfully adopted the scorecard system recommend grading vendors on five to 10 measurable areas, like –
• Claims processing. Are employees’ medical claims turned around in a timely fashion? Are you hearing complaints that the explanations of benefits (EOBs) are slow to arrive or hard to understand?
• Disputed and resolved claims. Do worker questions and complaints about denied or still-pending claims get answered quickly and thoroughly? How often are you forced to go to bat for employees?
• Accessibility. Are plan reps quick to answer phone calls? Do they attend regularly scheduled meetings?
• Reports. Do you receive timely compensated claim and utilization reports?
• Open enrollment. Did you receive effective support preparing for and conducting open enrollment events?
• Employee education. Do your staff find the written and/or one-on-one services provided through the plan helpful in answering questions about managing specific chronic conditions (such as diabetes or depression)? Do you receive support in educating your staff to make healthful lifestyle choices, such as use of tobacco cessation?
2. Select a workable rating scale
There are two schools of thought when it comes to picking a rating method – subjective or objective. A lot of benefit pros – specifically those from smaller firms – use a simple pass/fail or 1 to 5 score to rate their satisfaction.
Others develop more elaborate, statistic-based ratings. One method – take the vendor’s guarantees (e.g., addressing disputed claims within 3-5 business days) and then measure by percentage how often these objectives are met.
These rating data can be obtained through quarterly performance reports, worker surveys, issue and complaint files and, for larger plans, external audits.
3. Feedback triggers improvement
It’s good practice to share your scorecard system with the vendor before meeting to review the results. Reason – This lets you iron out any vendor questions about the review categories and scoring system.
Once that’s settled, you are able to meet to go over the numbers and prioritize the areas that need improvement. Many firms then add a new scorecard category – providers’ followup.