HealthPartners retains NCQA's top accreditation status

For the ninth year in a row, the National Committee for Quality Assurance has awarded HealthPartners "Excellent" accreditation status for its HMO and POS plans. NCQA reserves its "Excellent" status for health plans that demonstrate levels of service and clinical quality that meet or exceed stringent requirements for consumer protection and quality improvement.

The accreditation is based in part on the Consumer Assessment of Healthcare Providers and Systems (CAHPS) Survey, in which HealthPartners ranked first in Minnesota in Member Satisfaction.

HealthPartners scored above the national average in seven of nine key areas, and was consistent with the national average in the other two. HealthPartners scored significantly higher than the national average in:

Claims processing
Rating of the health plan
Rating of doctor
Getting care quickly
Customer service

NCQA is an independent, non-profit organization dedicated to measuring and improving health care quality. Learn more about NCQA.

Flu vaccination coverage

Are your employees asking how HealthPartners covers both the seasonal flu vaccine and the H1N1 vaccine? Both vaccines are covered under the member’s in-network preventive care benefit. Here are some additional details:

Flu shots are covered under the preventive care benefit. If you do not offer 100 percent coverage for preventive care, the member will pay a copayment or deductible/coinsurance for the flu shot.
When a member gets a flu shot from a network provider, the provider will bill HealthPartners directly and we’ll pay the provider. The member is responsible for paying only member liability (if there is any).
If a member uses a non-contracted provider, we will cover the flu shot at the in-network preventive benefit level, but the member will need to submit the claim manually. For example, Walgreens is not contracted to provide flu shots to our members. Members who go to Walgreens will need to pay for the flu shot and submit a claim for reimbursement.
The federal government is supplying the H1N1 vaccine at no cost to providers. HealthPartners will reimburse providers the cost to administer the H1N1 vaccine.

For more information, please visit the Employer Flu Toolkit.

HealthPartners public policy platform

We get a lot of questions about where HealthPartners stands on health care reform. HealthPartners public policy position is designed to achieve the “Triple Aim”– to simultaneously optimizing the health of members, the patient experience and reducing the per capita costs of care.

In alignment with the “Triple Aim,” we’d like to see health care reform address the following key issues:

Everyone should have affordable health care coverage.
Payment systems must reward value, (quality and efficiency) not volume.
Quality, costs and incentives should be as transparent as possible.
Reform of federal and state regulation is needed to support and encourage an effective market.
Government policy should encourage healthy lifestyles and support health promotion.
Government should establish public health goals, and strengthen the role of the public health system.

Learn more about HealthPartners Public Policy Platform.

Review of prescription utilization

We’re re-examining prescriptions submitted by physicians as Dispense as Written (DAW1) to further support health care affordability.

Currently, if a brand-name medication is submitted as a DAW1 by the physician and a generic version is available, the member gets that medication for the brand copayment or coinsurance amount. However, if the member requests the brand medication because they don’t want to take the generic version (submitted by the pharmacy at the member's request), the member pays the brand copayment or coinsurance amount plus the difference between the cost of the two medications. We want to make sure that all prescriptions written as DAW1 are because of medical necessity.

On November 1, 2009, members with DAW1 prescriptions will be sent a letter advising them to contact their physician about submitting a request for prior approval to HealthPartners by January 1, 2010. This request will be reviewed for medical necessity. If there is a medical reason the member must take the brand medication, then the member can continue to pay the same copayment or coinsurance amount. If it is not medically necessary, then on January 1, 2010 the member will either need to switch to the generic version or pay the brand copayment or coinsurance plus the cost difference between the brand medication and its generic version.

The generic versions of these brand medications have been thoroughly tested by the Food and Drug Administration (FDA) and are considered just as effective as the brand medication. This initiative is designed to further promote the use of generic medications and to ensure that higher cost medications are only used if medically necessary. Going forward, any DAW1 prescriptions will require prior approval and will be reviewed for medical necessity. Learn more about HealthPartners prior approval process.

Wisconsin benefit and eligibility mandates

Below is a summary of state-mandated changes for Wisconsin plans.

Age 27 Eligibility Mandate

Coverage must now be extended to individuals through age 26 (up to age 27) regardless of student status. This applies to both medical and dental plans.
If the dependent was a full-time student when called to active military duty, he/she is eligible to be covered under the plan upon return from service as long as the dependent continues to be a full-time student (no end date).
Based on a similar mandate in Minnesota, we expect this mandate will increase overall health care claims by an additional 1.7% in the first year and .6% in the second year. We will be adding this charge to all large group renewals starting January 1, 2010.
There will be no rate impact to Wisconsin small employer plans because our current rating method accounts for family size.
This mandate is effective 1/1/2010 as groups renew.

Autism Benefit Mandate

This mandate does not apply to Preferred Provider Plans so we will not be implementing this mandate for our fully insured Wisconsin book-of-business.
The mandate applies to self-insured government entities. HealthPartners will implement the mandate for these specific employer groups.
Mandate is effective 11/1/09 as groups renew

Other Benefit Mandates

The State of Wisconsin passed mandates regarding coverage of cochlear implants and contraceptives. While the mandates do not apply to Preferred Provider Plans, HealthPartners covers these benefits as standard. Our Wisconsin plans already cover both cochlear implants and contraceptives.
These mandates apply to self-insured government entities.

For more information, please contact your HealthPartners sales representative or your broker.

Save the date: 2010 Purchaser Symposium

As we look forward to next year, we wanted to make sure to get the date for the 2010 Purchaser Symposium on your calendar. The 2010 symposium will be held on Thursday, February 11, 2010 at the RiverCentre in Saint Paul, Minnesota. Please mark your calendar and watch for more information in the next few months!

To learn more about last year’s event, please visit healthpartners.com/symposium.