Employee Health Plans: Beyond Kicking the Tires

Behind the Curtain

BHCAG, a coalition of Minnesota employers working to make the health care system more consumer friendly, sent the eValue8 survey to 12 health plans in the Upper Midwest in 2005. Seven insurers opted to complete it:

•  Blue Cross and Blue Shield of Minnesota, based in Eagan;

•  Bloomington-based HealthPartners, Inc.’s HMO and PPO;

•  Patient Choice Healthcare, Inc., which is owned by Medica;

•  Medica Health Plan’s HMO, based in Minnetonka;

•  Philadelphia-based Cigna’s Minnesota PPO; and

•  Sioux Valley Health Plan’s HMO, which is headquartered in

    Sioux Falls, South Dakota.

The plans are evaluated in performance areas that employers identified as key to their purchasing decisions. These included health information technology, consumer engagement and support, chronic disease management, program administration, patient safety, pharmacy management, and more (see sidebar for complete list). Local plans also can see how they rank against national insurers with the top scores in each category.

“Few companies really know what they’re getting in terms of quality or efficiency for their premium or insurance dollars,” says Carolyn Pare, CEO of BHCAG. “This tool helps open up the ‘black box’ and show how health plans are performing in critical areas, giving purchasers comparative data rather than marketing information on which to base their buying decisions.”

The rigor of eValue8’s information gathering and data verification process is a big selling point to employers. Once health plans electronically submit their data, a specially certified eValue8 scoring team verifies the information, asking clarifying questions and requesting supporting documentation as needed. “It requires an integrated and holistic response from health plans, which in our case means bringing groups of people and departments together [in] real time to examine questions and dig for information,” says Larry Bussey, director of communications for Medica. “The questions are very specific and data driven, and help articulate those things purchasers are looking for beyond price. It’s not about providing nice marketing language, but about how plans document and quantify their performance.”

Organizations such as the Centers for Disease Control and Prevention in Atlanta, the Substance Abuse and Mental Health Services Administration (which is part of the U.S. Department of Health and Human Services), and the Baltimore-based Centers for Medicare and Medicaid Services all contributed to development and refinement of eValue8, Pare says, lending it additional credibility in users’ eyes. In addition, the Smart Buy Alliance, a partnership of Minnesota government and private employers, is using the survey results in its health care purchasing decisions. Together, Alliance members buy health insurance for about 60 percent of Minnesota residents.