pediatric health software

Consumer Directed Health Plans (CDHP) in Pediatric Practices

June 7, 2012 in Uncategorized by support Team  |  Comments Off on Consumer Directed Health Plans (CDHP) in Pediatric Practices

What is a Consumer Directed Health Plan (CDHP)?
A CDHP is a health plan option for which the family usually has a high deductible of $1500, $2500, $3000 or higher. The individual that has this high deductible is ‘trading’ the high deductible for lower Health Insurance Premiums. Additionally, a family might save money in a health care savings account for use when in the deductible phase. The family can roll over money from year to year in the Healthcare Savings Account.
Do all CDHP plans have a high deductible for well visits at a primary care Pediatric Office? No. Many CDHP plans cover well visits which usually includes vaccines. In most cases, the deductible/co-pay is $0.

How common are CDHP plans?
CDHP plans, due to the ability to save the employer and employee cost on the premium are growing in popularity. It is estimated that approximately 50% of small employers offer this option and between 20-30% of Medium to large employers. Many employees prefer to work with the ‘known’ and therefore select the traditional HMO and PPO plan. In Pediatrics, parents usually try to offer a plan that has more coverage due to the need to treat their sick kids. We evaluated some of our Pediatric groups and noticed that CDHPs are significantly below 10% currently.

How might CDHP Plans impact my Pediatric Practice?
Studies show that patients whom are insured using CDHP plans have between a 10% and 20% utilization rate of outpatient care. These studies do not look at the impact of Pediatrics versus specialists and other forms of outpatient care. Parents with this type of insurance are much more knowable of what their policy covers versus parents whom have traditional HMO/PPO coverage. Many will check to see what the plan covers as well as request generic medications versus branded medications.

How might CDHP Plans impact my collections and AR Rate? If a pediatric practice did not have strong patient responsibility follow-up as well as a high penetration of CDHP plans, the practice might see the collection rate reduced as well as an increase in AR days. The Medical Group Management Association as well as other organizations provides benchmarks for collection rates and AR days. The average collection rate is around 95% of the contract amount with 97% used by many groups as a benchmark. Achieving well above 99% consistently should be the minimum benchmark for each Pediatric Practice. Related to AR days, a pediatric group should have AR days less than 30 (less than 30 days of Accounts receivable) with the goal of being at 25.

Although CDHP plans are just starting to penetrate the market place they will continue to be an offering as the country struggles with rising healthcare costs. Monitoring and Management of CDHP plans is one component that will help improve the success of a Pediatric Practice.

Customer Service and Pediatric Practice Management

May 11, 2012 in Uncategorized by support Team  |  Comments Off on Customer Service and Pediatric Practice Management

I had a HORRIBLE customer service experience with a technology company this week. During business hours, I waited on hold for 29 minutes prior to a representative being available. After about 20 minutes on the phone with the customer service representative, it was obvious that she did not understand the issue
or how to resolve. She asked for another 20 minutes to check out some aspects of the issue but was unsure if she would be able to resolve the issue (technical issue with a phone they support for us). At this point I was extremely frustrated and needed to take charge of the call to provide options to her (she should have provided the options to me). She did not have an understanding of the problem for us – unsure if it was lack of listening skills or lack of knowledge. Investing more of my time on hold would have increased my frustration so we terminated the call with no resolution – missed opportunity. What could have this organization done differently? Plenty. First, no customer should wait more than 5 minutes to speak to a customer service representative. Management needs to be on the hook for staffing as well as monitoring customer service. Second, the company posted a ‘green light’ on their systems while the customer representative stated there is a major problem with their systems. The internal processes and procedures need to align when there is a problem. There are other items this company could do to further the customer service experience after they can move to an acceptable/basic level. Although we are not perfect, we are on the pursuit of perfection each day which causes continuous improvement of a ‘good’ customer experience. Constant re-engineering of processes and methods should be the norm with all organizations including the investment of people and resources.

How does this relate to Pediatric Practice Management? Pediatric practice management requires good customer service. When a patient calls during business hours, they need to be able to speak to a live person without waiting for more than a few minutes or receive a voicemail that they can leave a message when the question relates to a bill or other administrative function (e.g. follow-up on insurance information). Also, patients need to be able to leave a message any time after hours (this saves them time). We have picked up clients for which the previous billing service did not provide this level of service. Appropriate level of service is critical to managing the revenue cycle and the revenue cycle is a ‘team’ effort.