5 Ways Care & Coverage Work Together to Save Employers Money

For years, Group Health (now Kaiser Permanente) has been touting the advantages of medical care and health coverage working together. But what does that really mean? And how does that approach benefit employers considering health plans for their employees?

Here are five ways how your company and employees can benefit from care and coverage being in lockstep.

1.  Keep costs down

Most care providers are at the mercy of compensation rates set by insurance companies for their services. To compensate, doctors often see more patients or order more tests. So your employees don’t get the time and attention they rightfully deserve, and you both pay for tests or procedures that might not be necessary.

At Kaiser Permanente, care and coverage work together. Plans and physicians arrive at mutually agreed upon compensation. Doctors aren’t pressured to make up for lost income. Decisions are made in the interest of a patient’s health, not a provider’s bottom line.

2. Keep employees healthy

Both plans and providers emphasize preventive care and evidence-based treatment. The first helps keep your employees from getting sick in the first place, and mitigates costs when issues do arise. The second follows treatment protocols demonstrated to provide care in the most effective and efficient ways possible. This approach helps reduce employee absenteeism and corresponding lost productivity.

3. Ready made high-performing networks

At a time when many health carriers are rushing to incorporate high-performing, narrow networks* into their plans, Kaiser Permanente already offers an established, integrated plan with its own high-performing medical group, system of medical offices, and additional in-network contracted providers.

On the care side of this equation, Group Health Physicians (now Kaiser Permanente Physicians) is the highest-ranked medical group in the state.1 In pharmacy management,2 Kaiser Permanente (as Group Health) scored higher than Aetna, Cigna, Regence, and United Healthcare (Premera declined to participate).

4. Exceptional health plans

All of the above has helped contribute to our commercial HMO being named the top-performing health plan in the nation.3 And the top-performing plan for helping members get and stay healthy and for treating chronic conditions.

Should you wish to offer your employees more provider choice, there’s our Access PPO, the top-rated such plan in Washington.1 If you choose, you can offer both HMO and PPO plans together as part of a total plan replacement strategy.

5.  Integrated care and convenience

The entire Kaiser Permanente model of care is derived from doctors working with plan developers and product managers to arrive at an optimum combination of services, products, and benefits to keep employees and their families as healthy as possible.

Take receiving care at a Kaiser Permanente medical office. Electronic medical records put a patient’s health history at any providers’ fingertips. Our integrated care model care allows a primary care doctor to coordinate a patient’s care with everyone from specialists to pharmacists. And patients can visit their doctor, get X-rays, fill prescriptions, and get lab results usually under one roof.

Our physician and plan groups have collaborated in developing multiple avenues of care, from the free 24/7 Consulting Nurse Service to walk-in clinics at select Bartell Drugs. Both services are available to all Kaiser Permanente plan members, not just our own clinic patients. Such venues give your employees options that may be more affordable or convenient given their medical issues. This leads to faster treatment and fewer hours off the job.

Our plan developers and physicians also work together to help employers fashion customized plans that meet their unique needs. These may include special funding options, incentive-based wellness programs, tobacco cessation efforts, focused chronic disease management, and more.

 

 

*  Society of Human Resource Management defines high-performance or narrow networks as “exclusive groups of high-value health care providers and health professional organizations recruited to serve a defined population.”

†  Criteria established by American Medical Group Association

1.  2016 Community Checkup, Washington Health Alliance

2.  2014 Washington Health Alliance Report

3. Group Health Cooperative’s commercial HMO rated the top health plan in the United States in the 2016 eValue8™ survey. Managed by the National Business Coalition on Health, eValue8™ is an evidence-based resource created by business coalitions and employers like Marriott and General Motors to measure and evaluate health plan cost, quality, and performance.