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SCHAUMBURG, Ill.-Motorola Inc.'s unique health care network incorporates the company's culture, focuses on quality and health rather than cost-cutting, and has overwhelmingly won over its employees.
A majority of Motorola's 75,000 U.S. employees have given up on health maintenance organizations or indemnity-plan coverage, preferring instead to enroll in the customized provider network that the electronics company built around worker preferences.
When Motorola launched its Health Advantage Plan on Jan. 1, 1996, the company's benefit managers "guesstimated" that 25% or 50% of the employee population would sign up, said Randall L. Johnson, Motorola director of corporate benefits planning in Schaumburg, Ill. But during its first year, nearly 60% of employees switched to the Health Advantage Plan from an indemnity plan or HMO. Today, 70% of employees nationwide participate in the network, and a recent "customer satisfaction" survey conducted by Motorola revealed employees appreciate the plan over their previous coverage.
Mr. Johnson does have one paramount worry these days, and that is why he has been presenting Motorola's health plan to other employers and the public as he did earlier this month at the National Managed Health Care Congress in Los Angeles.
Motorola is concerned that Congress' current focus on remedying perceived flaws in managed care could result in "additional mandates that will preclude companies such as Motorola from using the business initiatives and innovative capabilities to improve the health care delivery system," Mr. Johnson said.
Therefore, even at the risk of losing the competitive edge that the company's health plan provides in attracting and retaining employees, Mr. Johnson is willing to share it with other employers to show that employers working under their own initiatives can improve quality.
Although Motorola does weigh cost considerations, the creation of the Health Care Advantage plan was driven by a desire to improve health care quality and employee health, not just cost reduction, Mr. Johnson said.
In fact, convincing medical providers and the few vendors that Motorola worked with that quality care is paramount to the employer was the greatest challenge it faced in its massive effort, he said.
With so many organizations in the health care delivery system focused primarily on cost reduction, it was no small matter to change their mind-set, Mr. Johnson said.
"This is clearly a counter trend. The trend we are still seeing in the industry as a whole is a migration toward more tightly-managed managed care and more restrictions as opposed to fewer, as well as more burden being placed on the employee," said Dr. Richard C. Gayes, vp of provider network quality for Private Healthcare Systems Inc. in Rosemont, Ill. Motorola turned to PHCS to build the network to the employer's specifications.
Motorola's approach is different from that of HMOs, whose restrictions on care have created a public backlash, Dr. Gayes said.
He said it all stems from Motorola's willingness to financially back its belief that more care will eventually reduce costs, while other companies' efforts are still focusing on increasing employee contributions as a way to hold down utilization.
Before creating its health plan, Motorola engaged 150 employee focus groups nationwide, conducted employee surveys and studied available benchmarking data.
The focus groups and surveys pinpointed employee areas of dissatisfaction with their existing health care plans, such as typical HMO rules that forced them to see a gatekeeper before receiving treatment from a specialist.
Additionally, there had been difficulties with HMOs that did not inspire employee confidence. Such was the case when one large clinic and an HMO announced they were parting ways, right after open enrollment and their coverage was set to begin.
About 16% of Motorola's U.S. employees are now enrolled in HMOs, compared with 33% in the early 1990s. The company contracts with about 30 HMOs nationwide.
A Motorola survey taken during the second quarter of this year revealed that 94% of the workers in the company's Health Advantage network reported overall satisfaction with the plan. That compares with 86% of those who remain in HMOs and 79% still in the company's indemnity plan, Mr. Johnson said.
Survey results also revealed that 93% of employees in the Health Advantage Plan prefer it over the plan they were enrolled in the previous year. That compares with 80% enrolled in HMOs who said they like their plan better than the one they were in the previous year and 71% of indemnity plan enrollees who responded similarly.
While those results are positive and show that Motorola is meeting employee health care desires, there are still improvements to be made, Mr. Johnson said. For example, "Motorolans" still are not satisfied with the average time they spend in doctors' waiting rooms.
That attitude stems in part from Motorola's culture, in which constant product and customer satisfaction improvements are expected from everyone along with reductions in product delivery time. Everyone within the company must continually work to make those improvements and eliminate mistakes.
No less is expected of employee benefits delivery, so the company created its own medical network based on that company culture and business goals.
Mr. Johnson will not disclose Motorola's medical plan costs, but he did say they have been lower than average costs for other companies.
He also said that, "Our costs for this coming year for our Health Advantage Plan are expected to remain constant to last year."
In its drive to create its own network, the company did not work with a typical array of employee benefit consultants, Mr. Johnson said.
"We do use Towers Perrin as an independent third party to evaluate the performance of our HMOs, but for installing this program, it has been pretty much a team effort of my colleagues within Motorola," he explained.
Because of the desire for quality and to meet employees' specific desires, Motorola also decided an "off-the-shelf" health care network would not do.
So Motorola partnered with Waltham, Mass.-based PHCS to build its network. Nationwide, 107,000 doctors are in the PHCS network along with 932 hospitals and 4,100 mental health care providers.
PHCS is owned by a consortium of health insurers.
To build the network, Motorola and PHCS reviewed past employee medical claims. Doctors listed on 10 or more claims were invited to participate.
Motorolans can also make recommendations.
"We believe that the people who have the experience with the doctors have a quality statement to make, and whenever a Motorolan recommends a provider, we pursue that provider for inclusion in the network," said Dr. Gayes of PHCS.
Doctors must pass a tough credential screening process. For example, included in the screening process for mental health pro-viders is an essay-type test in which they choose one of three case studies.
Their answers are reviewed to see if they pass a standard for managing that case. They must also interview with staff members of Motorola's employee assistance program.
Nationwide forums were held for doctors to provide program improvement input and to learn how Motorola's business initiatives apply to health care delivery, and that customer satisfaction is their goal. The doctors also must learn the broader array benefits that Motorola provides its employees in the Health Advantage Plan.
The plan includes 90% coverage with no deductible or gatekeeper, no claim forms that must be handled by the employee, and vision and hearing care. Employees in the plan are required to take a yearly blood test and blood pressure exam for preventive health care purposes.
Another unique aspect of the plan is that utilization review is advisory, not binding on pro-viders.
Single employees pay about $25 per month to participate and $50 per month for family coverage. That is less than employees typically pay for company-sponsored HMO coverage, Mr. Johnson said. Employees are signing up for the Health Advantage Plan because of those premium savings and the desire for better-quality care.
Health Advantage Plan coverage also includes disease and drug management care that Mr. Johnson prefers to refer to by the Motorola name of "Essential Quality of Life Programs."
A cholesterol, high blood pressure and heart failure program was introduced in September. An asthma and pulmonary disease program was introduced last month, and an infections, depression and gastrointestinal disorder program will begin in December.
Mental health and drug dependency benefits within the Health Advantage Plan also are rich, which runs counter to the practice Motorola found in place for many other employers and HMOs.
"What we have found (is that) the HMOs are only allocating small amounts for mental health care, which essentially keeps people out of care," Mr. Johnson said.
Motorola's Health Advantage Plan's mental health benefits cover group and family care.
Under those mental health benefits, medical necessity is defined broadly so that it covers issues that are "significant stressors" at work and home, Mr. Johnson said. Mental health doctors are not required to pre-certify outpatient care. Providers with established records within the network are asked to discuss the client's progress with network managers after 20 visits.
Heaping on the benefits is expected to reduce long-term company costs as employees miss fewer days of work and remain more productive, Mr. Johnson said.
Putting together the network was "a major, major effort, and it took us a lot longer to be ready to implement this than we expected," Mr. Johnson said.
But now that it is in place, he does not expect Motorola has incurred any additional risk.
"We don't think we have absorbed any additional liability, because PHCS is building the network," he explained. "Motorola is not evaluating or credentialing doctors, although we have worked with PHCS to establish credentialing criteria."
There is also a difference between denying care and establishing what is covered, he said.