Concierge Care

Posted on Mar 1, 2011 :: Cover Story
Posted by , Insight on Business Staff Writer

Photo by Shane VanBoxtel of Image Studios

In the age of robocalls, online medical records and complicated insurance statements, there’s something about the personal touch that matters a lot to Sheila Jenkins.

“The ability to get questions answered in person or on the phone with someone locally in a way they can understand is huge,” says Jenkins, president of Network Health Plan.

So, for example, when Lucy Valitchka selected Network Health Plan as her Medicare Advantage provider upon retirement eight years ago, she found comfort knowing she could pick up the phone or walk into the office on Midway Road in Menasha and get answers to her questions on the spot. She especially likes Network’s concierge service, which links Medicare clients with a dedicated customer service rep who answers questions about everything from an explanation of benefits statement to whether to get a flu shot. “They are such a good resource for health information,” she says. “If you need to know something, they’re there to help you,” she says.

At a time when health insurance companies are not exactly on the top of everyone’s favorite business list, Jenkins has quietly led Network to become a leading regional insurance provider focused on improving the health of its members while keeping the organization in the black.
A division of Affinity Health System – the operator of three hospitals, including St. Elizabeth’s in Appleton and Mercy Medical Center in Oshkosh, and the Affinity Medical Group – Network Health carved out a niche in an industry where giants such as UnitedHealthcare and Humana reign.

“Our members like they can see us and touch us,” says Jenkins. Polished, knowledgeable and an expert on the often overwhelming changes in the health insurance industry, the certified public accountant speaks with passion about one thing: Network’s mission to deliver personalized care to its members.

As the State of Wisconsin puts the finishing touches on how to put together its insurance exchange, which will allow individuals more choice in their insurance choice and is part of the 2010 health care legislation, Network is hoping its ability to be nimble and adapt quickly to market changes will pay off.

“We really don’t know yet what the exchanges will look like, but it will definitely be a growth area for us since we’ll be able to offer more products,” Jenkins says.

“2010 was the greatest year of growth for Affinity Health System. During that year, we added new providers to Network and opened up Affinity to more insurers so I think those two things working together made that happen,” says Dan Neufelder, Affinity’s chief executive officer and Jenkins’ boss. “Consumers are demanding choice and that’s something we’ve been able to offer very successfully.”

From the ground up

Network Health was created in 1982 by a small group of health care providers in the Fox Cities looking to provide custom health insurance plans to local employers. In the past five years, Network flourished as the number of commercial and Medicare members grew from 70,736 to 109,630. To handle its growing number of customers, the number of full-time equivalent employees rose from 159 to 242.9 (Affinity, Network’s parent company, employs 4,007 – making it the Fox Cities’ second largest employer behind ThedaCare.)

While other regional insurers such as Touchpoint Health Plan were purchased by national firms, Network maintained its independence, despite operating in the red for several years at the start of the 2000s.

In 2005, the U.S. government created its Medicare Advantage program, allowing private carriers to administer and provide coverage to the millions of people on Medicare. The thinking was that private carriers would be more effective at administering care, especially to people with chronic diseases. To join a Medicare Advantage Plan, which provides extra benefits, a person must have both Medicare Parts A and B. Consumers found the Medicare Advantage Plans often had lower premiums and better coverage than the Medicare program.

“That was a huge lift for us,” Jenkins says. “In 2005, we had zero Medicare Advantage customers. Today, it’s 35,000. The Medicare Advantage programs fit well with who we are.”
For seniors looking at their Medicare options, Network’s high marks for service and local contact paid off. “Word-of-mouth was huge for us,” Jenkins says. “People were telling their friends, ‘you have to try Network out.’”

That’s something Jeffrey Prickette of McClone Insurance in Menasha hears a lot. The senior benefits consultant works with businesses on their insurance needs and having Network’s main office in the region is a definite selling point.

“It’s a huge advantage they have over other carriers. The level of service they’re able to provide is much more personal,” he says. “If there is a problem, you can just go right over to their office and talk about it with someone in person.”

When businesses look at Network as an option, the insurer’s small size is an advantage since it has less overhead and can complete on price, Prickette says. “They also have pretty significant discounts with local providers so they can offer lower premiums,” he says.

While Network has a strong foothold in the Fox Valley, Jenkins says the challenge remains to convince companies that are headquartered out of the region but have a presence here to give Network a try. “If you’re going to offer your employees options, we want them to have Network be one of the options along with UnitedHealthcare or whoever,” she says.

When Lutheran Homes of Oshkosh saw its insurance premiums increase 23 percent in 2008, human resources director Pat Kuffel Ebben knew she needed to do something. She met with Network Health to discuss options and was enrolled in the insurer’s pilot Millennium Program, a wellness incentive program that brings together health and wellness activities, targeted health education resources and proactive disease management.

Lutheran Homes launched several wellness programs, including a pedometer program encouraging its 325 employees to log their daily steps. Once they hit 60,000, they received a refund of $40 for participating in the program. “What that program did was really introduce wellness as part of the discussion. It got people excited about being healthy and it grew from there. For example, now we have healthier foods in our vending machines,” says Kuffel Ebben, adding that for 2011 premiums went up just 2 percent. “Our wellness programs are a huge reason why our premiums didn’t rise as high as some other employers.”

After seeing the success of the Millennium program, Jenkins says Network’s next goal is to create a wellness program for employers with fewer than 50 workers. “Smaller companies often don’t have the resources available to run a wellness program so we’re looking for ways to scale it back but keep it effective or provide more online tools and resources,” she says.

Network was easy to work with and always open to ideas and suggestions on how to make Millennium work better for participants, Kuffel Ebben says. “Across the board, people are just more engaged” with wellness, she adds.

That attention to detail and willingness to work with employers has helped Network receive the excellent accreditation from the National Committee for Quality Assurance every year since 2002. Network has also been listed among the top 50 health insurance plans in U.S. News and World Report’s NCQA Best Health Plans in America listings annually since 2004.

Another way Network seeks to keep costs in line is through an aggressive pharmacy program that touts the use of generics, Jenkins says. Generics routinely cost much less than brand name drugs and work just as well. “We have a great generic prescription rate – 75 percent of all prescriptions we fill are generic,” she says.

Joining forces

The days of being tied to one health care system through your insurance are over as consumers demand more choice. With that in mind, Network has put together agreements with health care providers throughout the region, including ThedaCare, Agnesian in Fond du Lac, Holy Family Memorial in Manitowoc and St. Vincent and St. Mary’s hospitals in Green Bay.

“Employers don’t want to ask employees to change their doctors so we’re trying to give as much choice as possible. We have a strong presence throughout the region,” says Jenkins. Bellin Health and Aurora Health Care are the only two large providers in the region that do not have agreements in place with Network.

Network filled a big gap last summer when it signed an agreement with ThedaCare. “Adding them really made us more attractive to employers,” Jenkins says. “When working with providers to add them to the panel, it’s all about affordability. We don’t want to expand our providers and then have our rates go up. So there’s a lot of negotiation: Will the provider take what we offer for that care? ThedaCare is a great partner since they are community minded, much like we are, and came in at reasonable reimbursement rates.”

Bill Mann, senior vice president of Ingenuity First, a division of ThedaCare, says linking up with Network Health made sense since it provided customers with more options. “This is just another avenue for people to seek our care. After many years of being a closed market, the Fox Cities has opened up and insurance plans now have access to both health systems (ThedaCare and Affinity). This means if your employer changes insurance plans, you don’t need to change your provider,” he says. “That means a lot to people.”

Back in 2005 before Network began its aggressive provider expansion, there were 1,405 HMO providers nationally. As of December 2010, there were 4,070 HMO/POS providers and 3,335 PPO providers. That increase – including last summer’s addition of ThedaCare physicians – made it more attractive to employers looking at insurance providers, Prickette says. “That was huge and I think will win a lot of employers over” to Network, he says.

Growing the commercial group market is essential as Network charts its future growth, Jenkins says. Since Medicare routinely reimburses providers at a lower percentage, having too many Medicare patients may lead to a tough financial picture.

Unanswered questions

One of the key pieces of the 2010 health care legislation was the creation of insurance exchanges where individuals and small businesses could theoretically buy insurance at the same rates as larger businesses. But like much with the new law, how that was to be done wasn’t spelled out – leaving much of the decision-making process up to individual states.

In Wisconsin, former Gov. Jim Doyle created a committee to look at how to create insurance exchanges and to present a plan to the State Legislature. But after the November elections and a new sheriff in town – Gov. Scott Walker – no one is sure what’s going to happen. Jenkins says Network tries to stay on top of the latest information and look at different options.

“There are a lot of unknowns,” she says regarding the exchanges. “We’re hoping that what comes out of the exchanges will be positive for Network.”

Neufelder believes Network’s ability to provide local service continues to set it apart from the competition. “Our members can call a local number and have their issues resolved right here in our community,” he says. “They don’t need to call a 1-800 number and call who-knows-where.”

Jenkins’ understanding of the entire health care industry is unmatched, Neufelder says. “Sheila has outstanding talent. She is not only intelligent, but also leads keeping in mind a deep sense of values that makes Network a place where people want to work,” he says.

In recent months, Affinity Health System signed agreements with UnitedHealthcare and Humana, which means the health-care provider now accepts nearly every insurance provider in the state of Wisconsin. That means employers who want their workers to have access to Affinity providers can now choose a UnitedHealthcare or Humana plan instead of something from Network.

That prospect doesn’t worry Jenkins too much since Network members now have access to ThedaCare providers. “That’s the same offering UnitedHealthcare has. Our advantage is that we are local and provide great customer service,” she says.

A year ago, Affinity began accepting patients with Anthem Blue Cross insurance and Network actually gained clients, which shows employers are choosing Network based on its entire panel of physicians, not just its connection to the Affinity doctors and hospitals, Jenkins says.

“We don’t really expect to see much of an impact from Affinity’s relationship with UnitedHealthcare. We feel it comes down to our superior service and being right here in the community. That is what will help us stand apart and hopefully more employers will then choose us,” she says. “In insurance, you’re not going to love every decision made, but being local allows us to provide an answer and an answer they can understand.”