Employees given voice in health care process

Organizations listen, respond to complaints

Employees who must choose from among a limited number of health care providers may feel they are on the low end of the health care totem pole. But a new report by a nonprofit organization in California shows that some employers and managed care providers are listening, and that employees can have an impact on the quality of health care they receive.

The report, issued by California Health Decisions (CHD), of Orange, CA, indicates that employees, as health plan members, can and do drive improvements in the health care delivery system. It also demonstrates how an ongoing dialogue impacted the plans, providers, and ultimately the employees themselves.

Called Partners in Healthcare: Consumer Input, Consumer Impact, the report is the result of a two-year CHD project. Participants included Chevron Corp., the third-largest petroleum corporation in the United States; Health Net, one of California’s largest managed health care companies; Hill Physicians Medical Group Inc., the largest independent practice association in California and recently named California’s "Blue Ribbon" medical group by the Pacific Business Group on Health; and two consumer partners who received their care through those organizations. Other members were interviewed via focus groups.

Identifying the issues

One of the first things the researchers did was identify major areas of frustration among the members — and often among physicians:

referrals and authorizations;

prescription drug coverage;

emergency room procedures;

member services;

issues surrounding the physician-patient relationship.

"These issues are not new," concedes Ellen Severoni, CHD’s president and co-founder. "What is new is the way in which the participants accepted ownership for the findings, shared accountability, and worked together to find solutions. It was an interesting evolution as health plans, physicians, employers, and consumers who have never shared the same table began to understand how they could help each other."

"It was very rewarding to be able to talk about the problems and frustrations that can happen when you’re seeking health care," says Culton Ingram, a Danville, CA, resident who was one of the participants. "But it was even more rewarding to be part of the solution."

Based on the feedback, Health Net and Hill Physicians have implemented a number of improvements, and expect to develop more over time. Here are some examples:

To make referrals easier, Hill Physicians expanded the length of time some referrals are valid from 90 days to 365 days, and established guidelines to permit automatic or "pass-through" referrals.

To improve communications with patients about referrals and authorizations, Hill also increased training for its nurses.

To improve understanding of the system, both Health Net and Hill revamped their member education materials, with direct input and content review from members.

To improve complaints about billing and claims service, Health Net and Hill developed a joint "one call" policy that institutes a three-way call to ensure that a billing or claims problem is "owned" or resolved the first time a patient calls.

To ensure a continuing voice for members in the development and evaluation of new policies and procedures, both Health Net and Hill Physicians have created new consumer committees that are already at work.

Interestingly, employees who have participated in the project had a different reaction to those changes than those who didn’t. "In the follow-up research, we found that members who had participated in the earlier sessions to identify concerns showed a higher-level satisfaction improvement than those who had not participated," notes Severoni. "This divergence demonstrates the value of inviting consumers to share their views and then responding with appropriate action. People want to know that their opinions counts."

"This was not an easy project, but it was worth the time and effort," adds Steve McDermott, executive director of Hill Physicians Medical Group. "What I learned is that we can never listen enough to those who use the services we provide."

[Editor’s note: Partners in Healthcare: Consumer Input Consumer Impact can be downloaded from the CHD Web site at www.cahd.org, or directly from CHD at 505 S. Main St., Suite 400, Orange, CA 92868. Telephone: (714) 647-4921.]