``Health Plans and Providers: Listen to Your Members'' Is Message of New Report Published By California Health Decisions.

ORANGE, Calif.--(BW HealthWire)--Nov. 2, 1999--

Health plans and physician organizations that are serious about improving patient satisfaction will find that their most valuable resource is their own membership, according to a new report issued by California Health Decisions (CHD), a nonprofit organization dedicated to involving the public in healthcare policy and practices decisions.

The report, "Partners in Healthcare: Consumer Input, Consumer Impact," highlights how health plan members helped drive improvements in their healthcare delivery system and how the continuing dialogue impacted the plans and provider organizations and the members themselves.

The report is a result of a two-year CHD Consumer Feedback Loop(SM) project where consumers discussed their concerns about their healthcare system and worked side by side with their health plan, physician organization, and employer to develop workable solutions. Project participants were Chevron Corp., the third largest petroleum company in the United States; Health Net, one of California's largest managed healthcare companies; Hill Physicians Medical Group Inc., the largest independent practice association (IPA) in California and recently named as California's Blue Ribbon medical group by the Pacific Business Group on Health; and two consumer partners who received their care through these organizations. Focus groups were held to obtain the views of other members. CHD organized and managed the project, which was initiated at the request of Integrated Healthcare Association (IHA), a statewide leadership organization on managed care issues.

The research phase of the project identified the primary sources of frustration among managed care health plan members, and often among their physicians -- referrals and authorizations, prescription drug coverage, emergency room procedures, member services, and issues surrounding the physician-patient relationship.

"The issues are not new," said Ellen Severoni, CHD's president and co-founder. "What is new is the way in which the participants accepted ownership for the findings, shared accountability, and worked together to find solutions. It was an interesting evolution as health plans, physicians, employers and consumers who had never shared the same table began to understand how they could help each other."

"It was very rewarding to be able to talk about the problems and frustrations that can happen when we're seeking healthcare," said Culton Ingram of Danville, a consumer who participated throughout the two-year period. "But it was even more rewarding to be part of the solution."

Patricia Moore of Martinez agreed. "It isn't often that you get the opportunity to make such a positive contribution to the community, or to have such an impact on the services my family and I need."

Health Net and Hill Physicians Medical Group took meaningful steps to make change where it mattered most, and members reacted positively, according to Severoni. "In the follow-up research, we found that members who had participated in the earlier sessions to identify concerns showed a higher level satisfaction improvement than those who had not participated," she noted. "This divergence demonstrates the value of inviting consumers to share their views and then responding with appropriate action. People want to know that their opinions count."

Health Net and Hill Physicians have implemented a number of improvements as a result of the research in this project, and more are expected to be developed over time. Some examples include:

-- To make referrals easier, Hill Physicians expanded the length

of time some referrals are valid from 90 to 365 days and

established guidelines to permit automatic or "pass-through"

referrals

-- To improve communication with patients about referrals and

authorizations, Hill also increased training for its nurses.

-- To improve understanding of the system, both Health Net and

Hill Physicians revamped their member education materials,

with direct input and content review from members.

-- To improve complaints about billing and claims service,

Health Net and Hill Physicians developed a joint "one call"

policy that institutes a three-way call to ensure that a

billing or claims problem is "owned" or resolved the first

time a patient calls.

-- To ensure a continuing voice for members in the development

and evaluation of new policies and procedures, both Health

Net and Hill Physicians have created new consumer committees

that are already at work.

-- To improve understanding of the system, both Health Net and

Hill Physicians revamped their member education materials,

with direct input and content review from members.

"This was not an easy project, but it was worth the time and effort," said Steve McDermott, executive director of Hill Physicians Medical Group. "What I learned is that we can never listen enough to those who use the services we provide. They have a great deal to tell us and it may be the most valuable information we can find anywhere."

California Health Decisions Inc. (www.cahd.org) based in Orange, is an independent, nonprofit organization that identifies and communicates public values on issues related to healthcare, bringing the consumer's voice to decisions affecting the delivery of healthcare. Chevron Corp., San Francisco (www.chevron.com); Health Net, Woodland Hills (www.healthnet.com); Hill Physicians Medical Group, San Ramon (www.hillphysicians.com); and Integrated Healthcare Systems, Walnut Creek (www.iha.org) participated in this project with CHD.

Note: Partners in Healthcare: Consumer Input Consumer Impact can be downloaded from the CHD Web site at www.cahd.org or ordered directly from CHD at 505 So. Main Street, Suite 400, Orange, Calif. 92868.