Health Plans First In Nation

September 26, 2005
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GRAND RAPIDS — Two local health plans have recently been recognized in national studies as being leaders in their fields. Grand Valley Health Plan was rated the best provider of diabetes care among the 281 plans included in a ranking by the National Committee of Quality Assurance (NCQA). Priority Health received the highest cumulative score in a study of more than 80 plans conducted by the National Business Coalition on Health (NBCH).

Grand Valley Health Plan (GVHP) treats diabetes care as a partnership, according to Dr. James Kerby, a physician and vice president of medical affairs for GVHP. The treatment begins with an overall assessment of the patient’s condition. Then, working as a team, doctors, nurses, dieticians and the patient agree on how they will progress toward a series of nationally recognized goals. These guidelines have to do with measurable items such as hemoglobin counts and blood-pressure levels. Although the health goals are universal, the process of achieving them is quite individualized.

“Basically we have a structured approach that holds accountable both our patients and our practitioners to reach goals as to how the diabetes is doing,” said Kerby. “Usually we find someone who can connect with them and get them to follow through and stick with the plan. So if we’re reaching our goals, it’s pretty evident. The goals are pretty concrete … and we use that as the accountability measure.”

The GVHP program was specifically recognized for its lipid screening, blood sugar level testing and monitoring kidney disease. In NCQA’s 2005 Health Plan Employer Data and Information Set, GVHP was ranked the best in Michigan in five of the seven measures considered essential to comprehensive diabetes care. GVHP also took a second-place ranking for its diabetic eye exam practices.

Priority Health was scored on eight categories in the NBCH review. The study, called eValue8, does not technically rank the health plans, it simply assigns scores to the plan providers based on their track record in the categories of pharmacy, behavioral health, primary prevention, consumer engagement, health information technology, plan profile, chronic disease management and provider measurement. The scores recognize “exceptional clinical outcomes and outstanding customer service” and are used by businesses in evaluating their health-care providers. In addition to having the highest cumulative score, Priority Health also took the highest individual score in the categories of chronic disease management, consumer involvement and health information technology.

That technology is part of the equation, according to Priority Health President and CEO Kimberly K. Horn, but so are the people and the products the company offers. Like GVHP, Priority Health has been investing in programs that allow the members to “take ownership of their health care now, not only in preparation for a consumer-driven health-care future, but because it’s the right thing to do,” Horn said.

For both GVHP and Priority Health, encouraging members to take a hands-on approach to achieving health goals has resulted in a new level of service, as well as cost savings. Horn said that as employees take a proactive stance on health and wellness, employers benefit in two ways. First, healthier employees have higher productivity and lower absenteeism rates. Secondly, a healthier work force is less of a drain on health infrastructure. Both of those factors can have a positive impact on a business’s bottom line.

“Employers want to move beyond treating health care as a commodity, which is what they do when price is the primary factor in their decisions,” said Dennis White, interim director for the eValue8 program for NBCH. By comparing the type of quality metrics provided by national studies, businesses can begin to understand the relationship between collaborative, proactive health programs and a long-term decrease in health-care expenses.

“The good news is that improving the quality of health care contributes to cost reduction, as well,” he said.    

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