CALIFORNIA HEALTH DECISIONS: Company Says Communication Is Key

      The Wall Street Journal/California Edition this week profiled California Health Decisions Inc., praising its president, Ellen Severoni, for finding "an outlandish solution to this state's seemingly endless battles over managed care: Conversation." Severoni helps large businesses negotiate with health insurers to purchase coverage for employees, working with influential players such as the California Public Employees Retirement System (CalPERS), Health Net and Chevron Corp. Her approach is unique, however, because she gathers "the employers paying for the health insurance, the managed care plans that sell it, the enrollees who use it and the doctors who provide the care" and doesn't let them leave "until the negotiators reach not only a consensus on what's wrong with managed care -- but also a commitment to fixing it." Severoni said, "This really has a lot to do with communication, and with the communication that people have about where to find the accountable bodies as they move through the system."

Let's Talk About It
     
      CalPERS health benefits administrator Margaret Stanley says the project is working. "We're coming up with the best practices and we're telling (HMOs), 'Use them if you want to keep your patients satisfied, if you want to be more successful in the marketplace." The Journal reports that these types of negotiations could be politically beneficial for the managed care industry, which will count it "as a win" if "consumers can be satisfied without new regulation." CalPERS is currently half-way through its four-year, $1 million project with CHD, and has started sharing with other HMOs the tips they've learned through the talks. CalPERS learned that patients are most often frustrated and confused trying to get a referral to see a specialist. So, its HMO, Health Net, has implemented the "Consumer Feedback Loop" where all three parties involved in the referral process -- the patient, the medical group and the insurer -- agree to make a three-way conference call "to avoid ping-ponging enrollees between their doctors and HMOs." Of her approach, Severoni said, "What surprises me is that it took an organization like mine to get the very important components of the health delivery system to sit down together. I've been feeling like this would work all along." However, Severoni says her work is far from over. "In health care, people do not yet understand the value of bringing concerns and, sometimes, misconceptions really close to the decision-making process. You need to keep the devil really close and to know what the devil is thinking," she said (Benson, 11/11). Click here to read coverage of CHD's report on patients' frustration with specialist referrals, or go directly to CHD's website -- www.cahd.org -- for more information.