Financial Performance
Revenue is up 9% and pharmacy spending is on budget. Although medical expenses have increased by about 7%, HNE has decreased its financial losses compared to 1998 by 50%.
The company is on track to return about 25% of the provider withhold*. HNE has been very aggressive in efforts to control expenses and has managed to contain administrative expenses to less than 13% of revenue.
* Return of withhold varies by risk pool performance. This is a company-wide average return.
Quality Improvement
Member Satisfaction
HNE thanks its provider network for cooperation in collecting data for the Hedis® Effectiveness of Care requirements. An annual assessment of member satisfaction is also conducted as part of compliance with HEDIS® requirements. Health New England scored well in a number of aspects of member satisfaction. (see chart on page 3). We have also identified a number of important opportunities for improvement as a result of the member satisfaction survey. On average, HNE members are less satisfied than members of other New England health plans with access to routine and urgent care and with the experience of care in provider offices. You will be hearing more from us as we formulate strategies to address these important issues.
Clinical Improvement Activities
HNE has a number of initiatives underway to improve the clinical care provided to HNE members. Among these initiatives are three disease management programs targeted toward members with asthma, diabetes and high-risk pregnancies (see related article on page 7). In conjunction with a number of our providers we are also working toward decreasing the variation in practice for the management of a number of common acute problems such as URI, pharyngitis and otitis media. A new behavioral health initiative is now underway to examine the management of depression in primary care practices. A series of CME programs on depression are planned for the near future.
Network Development
HNE welcomes the Permanente Medical Group (now known as Valley Medical Group) into our network. We look forward to the addition of many Massachusetts Kaiser Foundation Health Plan members in 2000. In conjunction with this medical group affiliation, HNE now has a contract with Cooley Dickinson Hospital. These new arrangements will improve access to care for our Hampshire County members.
Medical Services News
HNE continues to evaluate which procedures should require pre-certification. We recently decided to no longer require pre-certification for a number of surgical procedures, including several common ENT procedures and hysterectomy surgery.
A new internal staff committee, the Medical Policy Committee, has been established to help with Medical Services News implementation issues around the use of new technologies and procedures. The committee can make recommendations to the Medical Director, HNE’s Senior Management or HNE’s Clinical Care Assessment Committee.
