Every organization will be assessed from multiple angles. On the one hand, there are the customers to satisfy, the need to prevent attrition of good employees, and shareholders to impress. On the other hand, there are outside bodies that regulate industries, report on companies’ performance, and publish their findings. Health insurance providers are no exception. The Department of Health and Human Services (HHS) monitors this sector in the USA.
All these sources of information about how a health insurance provider are found in multiple places, making it difficult to know how one is performing as a provider. For example, clients may communicate their opinions during surveys or in letters of praise or criticism. These pieces of evidence would be hard to access.
We look at the factors that health insurance providers (HIP) are measured on. The emphasis is on how patients assess them and how external bodies measure them.
What Patients Look for in a Health Insurance Provider
Patients want a provider that gives them plentiful options so that they can elect the best fit for themselves. These plans must be flexible enough to be changed to suit the patient’s needs and preferences. Insurance plans must also be affordable.
Organizations that conduct patient surveys will derive a global customer satisfaction score. This is useful for comparing one HIP to another. Surveys will also assess how claims were handled and the quality of customer service delivered.
It should be mentioned that some employers contract with a HIP to provide an insurance service to their employees at lower rates. The employer typically pays half of the monthly premium. However, the employee is not able to choose the HIP that is best for them personally.
HIPs Measuring Themselves
Most HIPS have adopted a self-measurement approach, with many using HEDIS reporting. This stands for Healthcare Effectiveness Data and Information Set (HEDIS). This software service has become the key tool used by HIPs to measure themselves. HEDIS was granted approval for its measurement by the National Quality Forum, which is responsible for the standardization of health insurance providers’ measuring and reporting on the quality of a HIP.
In addition to the HEDIS, there is the Consumer Assessment of Healthcare Providers and Systems Health Plan Survey (CAHPS Health Plan Survey). It was also approved by the National Quality Forum.
When a HIP takes it upon themselves to monitor their own performance, this results in continual change as shortcomings are revealed. By using a standardized tool, results can be aligned with assessments undertaken by other parties.
Measurements Used
With multiple data, measurement bits can be combined in domains, which each receives an overall score. For example, if the domain is ‘caring effectively for patients”, this can be broken down into numerous specific measures.
It is equally important to assess the accessibility members have to a plan or gaining swift approval for a procedure. Similarly, what the level of care is that patients experience is also measured. Systems must be user-friendly and information easy to find. Descriptions of benefits must be described comprehensively, including the exclusions.
Remember that self-assessment is a valuable management tool for continuous improvement.
