Employer Health Insurance: A Move Back to HMOs

The health care plan pendulum appears to be reversing course. Years ago, as a reaction to the perceived restrictive nature of HMOs, the industry gave consumers expanded choice via PPOs. By 2002, the PPO was the most popular health benefit option for U.S. workers. But now, consumers appear willing to accept a narrower, coordinated care network as long as they still have control over their medical information. Thus, there’s a move back to HMOs

That’s the finding from a survey conducted by Accenture in connection with America’s Health Insurance Plans (AHIP) as reported in Modern Healthcare. The online article quotes Jean-Pierre Stephan, a managing director at Accenture, as saying, “Consumers don’t want unlimited choice. What they want is a few good choices.”

It’s not doctor choice, it’s the network experience

Consumers are more loyal to their preferred airline or hotel chain than their doctors, he adds. Only 26 percent of the 1,980 adults surveyed said they would definitely leave a network if their doctor’s participation ended.

Ninety-four percent said access to their medical records extremely important. They also valued things such as the ability to talk to their physician during and after business hours and tools such as online scheduling.

“The assumption is that consumers are going to stay in these networks if their doctors are in the network,” Stephan says. “(But) it’s not about the doctor, it’s about the network experience.”

How health plans are responding

As health care plans respond to consumer preferences, new services are being brought to market. Group Health (now Kaiser Permanente) has recently introduced a number of services to give its members and patients the combination of control and quality that they want.

Through our Core HMO plan, we offer what some employees are looking for: a sizable but select network of doctors plus an integrated, coordinated system of care. Under this plan, your employees have access to 9,000 providers across our service area, and the nearly 1,000 high-performing Group Health physicians (now Kaiser Permanente Physicians) practicing at our 25 medical offices, the highest-ranked medical group in the state. 1

Integration, online access, best practices

At our 25 medical centers, the entire clinic team—from primary care doctor to specialist, lab tech to pharmacist—has an up-to-the-minute record of your employee’s patient history via our integrated system of electronic medical records. This makes care safer, more efficient, and eliminates duplicative tests. Patients also have online access to care and clinical records. They can schedule appointments, e-mail their doctor, review lab and test results, read visit summaries, and check records of children under age 12.

The Core Plan’s additional 9,000 providers, who contract directly with us, are evaluated on a five-point scale of proficiency, far beyond the contractual arrangement most carriers have with providers. We work closely with these providers, sharing clinical guidelines and best practices, as well as helping them implement electronic medical records, practice evidence-based medicine, and improve outcomes and quality scores.

 

A King County employee’s cancer treatment shows Group Health’s coordinated care network in action.

  1. 2015 Community Checkup, Washington Health Alliance.