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Moving Beyond the Mysteries of Disruption Reporting
Date:6/11/2009

APPLETON, Wis., June 11 /PRNewswire/ -- Health plan transparency has gained an enormous amount of attention due to the ongoing "quest" to have better information to make informed health care decisions. While health plan transparency, provider cost or quality is often discussed in the form of better public information, there is an increasing need for transparency in reporting on member and claims disruption. The health care thought leaders in consulting firms, government agencies and large employers know that standardized reporting increases that transparency.

"The need to minimize disruption for customers when changing plans is a critical component," says Tom Dolatowski, Vice President Marketing & Communications, Delta Dental. Tom adds, "Our ability to provide transparency provides us with a competitive advantage." However, while the demand increases, the current methods of obtaining results can be misleading due to variations in the methodology used to determine if a provider is actually included in a health plan's network.

The Current State of Information Is Inadequate

Health plans are incented to create the appearance of minimal network disruption when responding to a proposal, and if not specifically instructed, may relax the method for determining a match to their network.

Consistent standards are not applied across various health plans, causing inconsistent results.

Data integrity is a challenge as it is often incomplete and does not reflect an accurate picture of the claims utilization over the previous year. Incumbent health plans, knowing they are "up for bid," deliver network provider data grudgingly, slowly, and in as cumbersome a format as possible, to hinder the analysis efforts of competing plans.

"Disruption analysis without transparency is of little value by itself," says Brett Apgood, Senior Associate, Mercer. "Simply having a li
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SOURCE Quest Analytics, L.L.C.
Copyright©2009 PR Newswire.
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