Key Questions for Health Plan RFPs

By: Denee Levineau, Kaiser Permanente Proposal Consultant

Over the years, I’ve seen quite a few requests for health plan information come across my desk. I’ve also seen how those requests have changed recently.

We average well over 100 requests for information each year, typically tied to the timing of an employer’s health plan renewal. In the past, larger companies have asked about basically the same types of things. For example, they want to know what our customer service response times are. Or what’s our accuracy in claims processing and enrollment. Some will even ask about value-added services such as disease and care management.

But now there’s a lot of interest in four key areas. Companies are looking for more ways to reduce their health plan costs. So they’re asking how we’re managing specialty medications and what we’re doing about cost transparency. Online medicine and wellness programs are also hot topics. Here, in part, is how Group Health answers those questions.

Specialty medications: Our board-certified, specialty drug pharmacists work closely with physicians and patients to manage therapies, encourage drug adherence, evaluate medication performance, and reduce drug interactions. For instance, we’ll dispense trial quantities to make sure a patient tolerates the drug and that the medication is working. That way, patients don’t end up paying for a complete prescription of a drug that’s not effective. All these steps and more have helped our total prescription drugs to cost 20–30 percent less in 2014 than the industry average.1

Wellness programs: Kaiser Permanente (formerly Group Health) offers a personalized suite of programs that help employees achieve their goals for better health and help employers maximize the economic value of a high-performing workforce. Our integrated approach brings together our top-ranked medical group,2 leading-edge online services, care management, and more. This integration means better coordination and service for your employees and more robust, insightful reporting for you.

We also conduct Plan Performance Profiles—more than 220 in the last six years—for companies with over 1,000 enrollees. With insights gained from these profiles, we’re able to share a number of recommendations in addition to wellness programs that can help companies reduce their overall health care costs and further improve the health of their employees.

Online technology: Companies are looking for more convenient ways for their employees to get the health care they need. Which is why you’ll find more and more walk-in clinics in the area. Providence Health is offering clinics in Northwest Walgreens. Rite Aid offers RediClinics. Nationally, many CVS Pharmacy locations have Minute Clinics. We have our own walk-in clinics. Kaiser Permanente offers CareClinics at 10 Bartell Drug locations with more to come.

Even more convenient is the option of virtual care. With online visits, plan members can receive diagnoses—even prescriptions if needed. Issues treated are common ones such as colds and coughs, allergies and infections. Typically within an hour. If members aren’t sure what type of care is appropriate, they can always call our Consulting Nurse Service 24/7 for guidance.

With so much of the workforce being digitally connected, employees also want medical help in the palm of their hand. Kaiser Permanente offers a mobile app. With it, any member can access our symptom checker, refill prescriptions, or direct dial our Consulting Nurse Service. Members who receive care at our clinics can also make appointments, check lab results, and more through their member website account.

Transparency tools: Employers are seeking ways for their workers to know beforehand what a medical procedure is going to cost. Before undergoing any kind of health care, from doctor visit to surgery, employees can get a cost estimate by calling our customer service desk. In addition, we’re in the process of installing a cost estimating tool on our website.

One thing that’s important to know is that when Kaiser Permanente members receive care at our clinics, they can always take advantage of lower in-network prices. They won’t be surprised if an expensive, out-of-network anesthesiologist, for example, ends up as part of their surgical team.

 

1. “The 2014 Drug Test Report Commercial,” The Express Labs, 2015.

2. 2015 Community Checkup, Washington Health Alliance.

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©2018 Kaiser Foundation Health Plan of Washington

All plans offered and underwritten by Kaiser Foundation Health Plan of Washington or Kaiser Foundation Health Plan of Washington Options, Inc.