Health Insurance Business Accountability.

Are your health care programs delivering on your vendors’ promises?

Just as importantly, how can you hold providers accountable when you’re not getting what you paid for?

Here is one proven way - Develop a provider scorecard. Scorecards alone won’t bring down your health care costs. But they’ll at least help make certain your organization â.” and workers â.” get everything you’re compensating for.

The tool can help you measure plan performance with greater precision â.” and identify specific areas that need improvement. Best of all, any organization can adopt the technique to fit their needs. Here is how it works.

1. Pick specific rating areas

Benefit pros who’ve successfully adopted the scorecard system recommend grading providers on five to 10 measurable areas, like -

o  Claims processing. Are employees’ medical claims turned around in a timely fashion? Are you hearing complaints that the explanations of benefits (EOBs) are slow to arrive or hard to understand?

o  Disputed and resolved claims. Do employee questions and complaints about denied or still-pending claims get answered quickly and thoroughly? Precisely how often are you forced to go to bat for employees?

o  Accessibility. Are plan reps quick to answer phone calls? Do they attend regularly scheduled meetings?

o  Reports. Do you receive timely paid claim and utilization reports?

o  Open enrollment. Did you receive effective support preparing for and conducting open enrollment events?

o  Worker education. Do your staff find the written and/or one-on-one services provided through the plan helpful in answering questions about managing specific chronic diseases (such as diabetes or depression)? Do you receive support in educating your staff to make healthy lifestyle options, such as use of tobacco cessation?

2. Pick a workable rating scale

There are two schools of thought when it comes to selecting  a rating method -  subjective or objective. A lot of benefit pros â.” specifically those from smaller firms â.” use a simple pass/fail or 1 to 5 score to rate their satisfaction.

Others create more elaborate, statistic-based ratings. One method -  take the vendor’s guarantees (e.g., addressing disputed claims within 3-5 corporation days) and then measure by percentage how often these objectives are met.

These rating data can be obtained through quarterly performance reports, staff member surveys, issue and complaint files and, for bigger plans, external audits.

3. Feedback causes improvement

It’s good practice to share your scorecard system with the vendor before meeting to review the results. Reason -  This lets you iron out any vendor questions about the review categories and scoring system.

Once that’s settled, you are able to meet to go over the numbers and prioritize the areas that need improvement. A lot of firms then add a new scorecard category â.” vendors’ followup.