Study finds MDs key to plan success
How providers relate to patients affects you
A recent study finds that physicians are crucial to a health plan’s ability to achieve high marks from enrollees. But case managers have the ability to affect many plan performance categories, as well.
The study conducted by the MEDSTAT Group in Ann Arbor, MI, surveyed health plan members in 20 U.S. markets and found three of the four categories ranked most important related directly to physicians. Physician-related categories account for 50% of a health plan’s overall rating by health plan members. Those categories include:
• choice of providers, defined as adequacy of the number of physicians to choose from and the ease of choosing a personal physician (17.1%);
• physician care, defined as listening skills and attentiveness of physicians and other health care professionals working on behalf of the plan and thoroughness of care provided (12.5%);
• time pressures, defined as physicians and staff being rushed and overworked (12%).
Other findings of The MEDSTAT Quality Catalyst Enrollee Study provide useful information for case management staffs trying to improve their organizations’ bottom lines and prove their worth. They include:
• Limits on care, defined as the level and type of care allowed from specialists and inappropriate limits on tests, medications, procedures, and types of care, contribute 6.7% to a plan’s performance rating.
• Customer service, defined as service representatives ratings in terms of courtesy, respect, friendliness, promptness in returning calls, helpfulness and knowledge, contributes 7.7% to a plan’s performance rating.
• Access to care, defined as difficulty or delays in receiving care, contributes 7.8% to a plan’s performance rating.
• Confidence in the health plan, defined as the level of trust members have that the plan will provide and pay for needed services, contributes 12.6% to its performance rating.
• Personal cost, defined as plan premiums and out-of-pocket expenses such as co-payments, contributes 7% to performance rating.
• Administration, defined as the type of services covered by the plan, availability of needed information about services and the amount of time spent filling out forms, contributes 5.9% to a plan’s rating.
• Decision-making style, defined as the extent to which physicians and other providers involve patients in treatment decisions, contributes 5.3% each to a plan’s rating.
• Waiting time, defined as the ease of making physician appointments and waiting time for appointments and the return of phone calls, contributes 5.3% to a plan’s rating.
In 1998, nearly 32,000 frequent users of health plans and more than 6,500 physicians rated nearly 150 health plans in 20 U.S. markets as part of The MEDSTAT Quality Catalyst Program. Results are published in market-specific reports that include comparative performance ratings and provide both local and national performance benchmarks.
[For details, contact The MEDSTAT Group, 777 E. Eisenhower Parkway, Ann Arbor, MI 48108. Phone: (734) 913-3000. Web site: www.medstat.com.]
You have reached your article limit for the month. Subscribe now to access this article plus other member-only content.
- Award-winning Medical Content
- Latest Advances & Development in Medicine
- Unbiased Content