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Multiemployer health plans negotiated by labor unions continue to offer workers a degree of insulation from the managed care revolution, a survey says.
But the study, conducted by the Brookfield, Wis.-based International Foundation of Employee Benefit Plans, also found that unions' indemnity or preferred provider organization plans have borrowed numerous administrative features from managed care to increase efficiency and save money.
The study examined 712 multiemployer plans that responded to a mail survey of 1,510 plans last spring. These plans are unique among health plans because they are governed by at least one, and often several, collective bargaining agreements negotiated by unions. The plans are governed by boards of trustees with balanced representation from management and labor and are most common in the construction trades.
The survey found that managed care has not affected these benefit plans as rapidly as has been seen in the single-employer realm.
Sixty-seven percent of multiemployer plans offered a preferred provider organization as a benefit option, yet 58% offered a traditional fee-for-service plan, the study found. If only one type of health plan was offered, 51% offered a preferred provider organization, while 34% offered a traditional plan.
Only rarely did a multiemployer plan require a worker to join a health maintenance organization. For all multiemployer plans responding, 29% offered an HMO; if just one option was offered, only 9% of the time was it an HMO.
Half of all multiemployer plans responding offered employees just one plan type, the survey found. Thirty-four percent offered two plan types, 12% offered three plan types, and four out of 100 offered four types.
The study also found that the kinds of plan types offered differed substantially depending on these variables:
* Geography. The plans in the western United States (Alaska, California, Hawaii, Nevada, Oregon and Washington) were much more likely to offer HMOs as an option to employees. About seven out of 10 of the Western plans offered HMO plans, compared with just 29% of all plans responding. It is in these states where HMOs got their early footing and where they continue to be most popular.
* Size of plan. Large multiemployer plans with thousands of workers are more likely to offer managed care. For plans with 5,000 or more members, 40% of plans offered an HMO as a choice.
* Type of industry. Construction trade unions tended not to offer HMOs. Just over two in 10 were offering HMOs, the survey found, compared with 39% of non-construction plans.
The survey found that, in most cases, multiemployer plans offer workers so-called ancillary benefits of prescription drugs, dental coverage, mental health benefits and vision plans. These benefits were offered by more than three-quarters of plans, with prescription drugs leading the way. Just under nine out of 10 multiemployer plans had prescription benefits, said Peter Alles, the senior research associate who conducted the study. Slightly more than 80% of the responding plans offered dental benefits.
The prescription drug benefit used a prescription card service 82% of the time and mail order services 63% of the time. Some employers offered more than one prescription drug option. Less than one-third of the multiemployer plans said they used a prescription benefits management company to handle drug claims.
Multiemployer plans that are not, strictly speaking, examples of managed care nevertheless have taken on many aspects of HMOs in order to manage costs, Mr. Alles said.
Two-thirds of plans said they have used case management and hospital precertification as standard tools, with more than half performing concurrent review, which is the review of patients' treatment while they are in the hospital, Mr. Alles said.
In addition, 46% of the multiemployer plans suggest a voluntary surgical second opinion. Seventeen percent require one.
Nearly three-quarters of plans with traditional plans or PPOs used more than one cost-management tool, and almost half used four or more. Only 13% used none of the techniques, the survey said.
More multiemployer plans have not formally adopted managed care structures because of the basic nature of labor negotiation, Mr. Alles said.
In a single-employer setting, human resources professionals can often follow their own preferences in determining health care options. In collective bargaining situations, however, employers may be willing to temper managed care objectives when other contract considerations, such as wages, are more pressing.
"(In contract talks), a group of people have to agree on change," he said. "It's a bargain- and-consensus-based process."
To receive a free copy of the survey, "Managing Multiemployer Health Fund Benefits," contact the public relations office of the International Foundation of Employee Benefit Plans, 414-786-6710, ext. 8219.