Best Practices of Highly Effective Health Plans

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1 Best Practices of Highly Effective Health Plans The Myers Group The Myers Group 0

2 BEST PRACTICES OF HIGHLY Best Practices of Highly Effective Health Plans tougher and more ambitious EFFECTIVE HEALTH PLANS The Myers Group September Best Practices of Highly Effective Health Plans What are the most highly effective health plans doing to be counted among the best in the nation? practices have these plans incorporated to propel them towards excellence and member satisfaction? What The Myers Group (TMG) has taken a close look at the best practices of these highly effective health plans. With extensive experience conducting healthcare survey research, and having conducted research each year for up to half of America s Best Health Plans 1, TMG is able to offer unique insight into some of the most common and consistent practices exhibited by these plans. The purpose of this paper is to share our findings and provide examples of the related strategies and philosophies that have made these plans among the best in the nation. The information presented here is based on: Analysis of TMG CAHPS survey results data collected for several of the top health plans and for those plans that demonstrated significant improvement in one or more composite areas TMG s research into common practices among the best health plans Interviews with several of the top health plans and those demonstrating significant improvement in one or more CAHPS composite areas Participation in the NCQA conference Quality Realized: Insights from American s Best Health Plans 2 BEST PRACTICES OF HIGHLY EFFECTIVE HEALTH PLANS 1. Make a Decision to Improve 2 2. Conduct Research 3 3. Set High Standards 4 4. Establish Strong Outreach Programs 5 5. Invest in Technology 6 6. Develop Effective Plan Designs 6 7. Manage Strategic Growth 6 1According to NCQA rankings published annually in U.S. News and World Report 2NCQA Conference titled Quality Realized: Insights from America s Best Health Plans, Arlington, VA February 12, 2009 CAHPS is a registered trademark of the Agency for Health Research and Quality (AHRQ) The Myers Group 1

3 1. Make a Decision to Improve The best plans did not accidentally find themselves at the top. It takes a corporate commitment to leadership and excellence. The most effective health plans are committed to a high quality caliber of staff and consultants. These plans reinvest their profits back into their business and create a corporate culture focused on quality improvement. All departments are involved The Decision To Improve Leadership Driven Communication is key Improvementoriented culture It takes corporate commitment to leadership and excellence. Common practices of plans that successfully make the decision to improve include: Quality improvement is leadership driven. It begins with senior management. All departments are involved. The decision to improve must involve all areas of the organization with clearly defined objectives and action plans. Communication is key. Decisions, philosophies, and goals are consistently communicated and reinforced throughout the organization. Improvement-oriented thinking and processes are ingrained in the corporate culture. Everyone in the organization assumes responsibility for helping to achieve company goals. Grand Valley Health Plan When Grand Valley Health Plan s COO, Pamela Lea Silva, presented at NCQA s Quality Realized: Insights from America s Best Health Plans, she emphasized that achieving excellence is leadership driven. They have a leadership-driven strategic focus on operational excellence for both systems and processes. Grand Valley Health Plan had two goals: 1) Achieve excellent accreditation 2) Attain HEDIS scores in the national 90th percentile for all measures In order to achieve these goals, everyone in the organization is involved in quality improvement, from the receptionist to the physician. This corporate-wide focus on quality improvement has resulted in Grand Valley Health Plan improving their ranking from 47th among America s Best Health Plans 1 in 2005 to the 4 th ranked health plan in According to NCQA ranking published annually in U.S. News and World Report The Myers Group 2

4 2. Conduct Research TMG s Call Center Satisfaction Insight Report Many plans conduct TMG s Call Center Satisfaction survey in addition to the CAHPS surveys to further identify factors which impact their members experience and overall satisfaction with the plan. The best plans start by assessing their current strengths and weaknesses. Plans carefully evaluate their plan data from CAHPS, HEDIS, and additional research, gathering member and provider feedback. Plans use this information to identify their strengths and areas for potential improvement. To provide additional insight, TMG developed a Call Center Satisfaction Benchmark component which gives plans the ability to compare their results with other health plans. Trends and aggregate results of TMG s Call Center Satisfaction Benchmark and the TMG 2008 CAHPS Book of Business were recently examined. TMG conducted a research study on the relationship between a member s customer service experience and their satisfaction and loyalty to the health plan. A summary of the key research findings are outlined in TMG s Call Center Satisfaction Insight Report. For a copy of this report contact: clientservices@themyersgroup.net The best plans make decisions by collecting and carefully evaluating data from: CAHPS survey results HEDIS results Claims/complaint trends Drill-down surveys/research Members quality of life Other According to Carla Parkes, Director, Care Management for CareSource Michigan, CAHPS is a good annual measure, but they also use other data to assess their strengths and weaknesses. We also look at HEDIS results, complaint trends, and other resources, states Ms. Parkes. We look at members quality of life as the end result of our efforts. CAHPS is a registered trademark of the Agency for Health Research and Quality (AHRQ) HEDIS is a registered trademark of the National Committee for Quality Assurance (NCQA) The Myers Group 3

5 3. Set High Standards Highly successful health plans set high standards for themselves, aligning their goals to compete with top health plans. As they achieve their objectives they continually set higher, more ambitious goals. Three common factors were found to be practiced by health plans that have successfully attained or are in the process of achieving their goals. These plans: 1) Set high standards for the organization Successful plans know they must set the bar high in order to be among the best. 2) Develop and execute a plan of action The best plans have a clear plan of action with regular milestones and checkpoints so the plan stays on track to meet their objectives. 3) Make certain everyone is on board This involves clear and consistent communication with frequent internal reviews to ensure each department s participation and understanding. Highly successful health plans set high standards for themselves, aligning their goals to compete with top health plans. The Myers Group 4

6 4. Establish Strong Outreach Programs The best health plans are committed to the development of outreach programs to build good relationships with their employees, their providers, and their members. These plans implement strong outreach programs and continually monitor their effectiveness. Common strategies to strengthen outreach programs among successful plans include: Providing bonuses and pay incentives to employees for meeting outreach goals; Creating opportunities to align with the provider community for example, establishing Pay-for- Performance incentives and working with in-house clinics; Ensuring members understand the plan design. These plans contact new members to discuss plan features, link members to providers and programs, and provide phone numbers and websites in case the member has questions later. Plans develop outreach programs to employer groups to provide their support, such as Lunch and Learns for their employees. These plans find ways to reach out to their community. For example, plans may participate in health fairs and/or work with community health centers. CareSource Michigan For this non-profit organization focused on quality improvement, their mission is bigger than just a good QI work plan. Carla Parkes, Director, Care Management for CareSource Michigan states, Our goal is to reach out to each member when they join the health plan and to work with them where they are. Their outreach programs involve skilled Health Coaches who are committed to ensuring members get the care they need. For instance, their Health Coaches do not just inform a member he/she needs to go for an exam. The Coaches are trained to guide the member to get this needed care while probing for any obstacles in getting to the exam. The Coaches assist the members in overcoming any obstacles. An example of their strong outreach effort is their weight management program. CareSource Michigan has partnered with Weight Watchers and the YMCA, and members are reimbursed for participating in the weight management program. The plan calls each new member soon after their enrollment in the program to provide support and additional information. CareSource Michigan works to understand the member s needs and overcome any barriers to getting care. The best plans practice constant outreach. The Myers Group 5

7 Best Practices of Highly Effective Health Plans 5. Invest in Technology Another common practice among high performing health plans is a movement toward automating processes and the establishment of Electronic Medical Records (EMR). This move helps prevent waste and lowers business 'noise,' allowing plans to hear the members directly. Many plans also offer members online access to lab results, prescription information, etc. 6. Develop Effective Plan Designs Successful health plans place emphasis on preventive care. utilize outreach programs a strong These plans to educate members on preventive care practices and often offer fitness benefits. These plans also have the highest number of providers per capita, allowing members greater access to care. Many of the best health plans are fortunate to have ties to academic medical centers where they can test the effectiveness of their designs. 7. Manage Strategic Growth Successful health plans find ways to manage growth, maintaining adequate numbers of PCPs, specialists, and hospitals. To manage their growth, these plans: High performing health plans are investing in technology and automating processes Continually review resources Take steps to ensure their resources are in line with their goals Utilize technology to support the organization s growth Health Plan of Michigan Health Plan of Michigan s President and CEO, David Cotton, MD, presented at NCQA s Quality Realized: Insights from America s Best Health Plans in February During his presentation, Dr. Cotton noted that leveraging technology is one of their key strategies. Leveraging technology and automated processes promotes consistency and has been part of Health Plan of Michigan s solution to help mitigate the challenges of rapid growth. Health Plan of Michigan has developed a comprehensive and integrated approach to quality. The plan has ranked among the top 15 Medicaid health plans in the country in 2007 and According to NCQA rankings published annually in U.S. News and World Report 1 The Myers Group 6

8 Excellence is Ongoing Highly effective health plans understand excellence is an ongoing process. Quality improvement must be a constant focus, and best practices must continually be reviewed, revised, communicated, and implemented throughout the organization. The Myers Group acknowledges our respect and commitment to these health plans dedicated to the improvement of healthcare in America. Contact Information: Clarissa Payne, Manager, Marketing Services The Myers Group 2351 Henry Clower Blvd., Suite D Snellville, GA / (770) cpayne@themyersgroup.net / The Myers Group acknowledges the following contributors to the research and editing of this article: Donna Barnhill, Sr. Research Consultant David Bahlinger, Executive Director of Research and Analytics Roseann Carothers, Director, Corporate Development Jean-Marie Ingemi, Sr. Account Executive Kim Rhyne, Sr. Account Executive Clarissa Payne, Manager, Marketing Services Citation: 2009 by The Myers Group. Best Practices of Highly Effective Health Plans. About The Myers Group The Myers Group is a nationally recognized survey research firm located near Atlanta, Georgia. For over 15 years, we have been dedicated to providing valid and reliable healthcare survey research to help plans improve quality and performance. The company is an innovative leader in survey design, data collection, analysis, and reporting. The Myers Group is an NCQA-Certified HOS and CAHPS vendor. Our mission is to serve the healthcare community by providing our service to organizations dedicated to quality improvement. Our focus is on the healthcare industry and quality improvement through advanced survey research. The Myers Group 7