• verifying provider access, to ensure that there are adequate numbers of providers to serve members of specific geographic areas;
  • requiring a standard benefit design that uses a standard definition for each benefit;
  • collecting and publishing performance and cost data in quality report cards, incorporating Health Plan Employer Data and Information Set (HEDIS) data;
  • managing and monitoring customer service through an ombudsperson program; and
  • monitoring and tracking complaints and grievances and how they are resolved.

This information enabled CalPERS to provide comparisons among plans and to negotiate better premiums. It also put the agency in a position to determine which plans it wished to continue doing business with in the future.

Evidence from Minnesota and Edison International on Structuring Choice for Retirees9

Evidence from Minnesota and Edison International demonstrates that factors other than comparability of health plan benefits must be considered when structuring choice for retirees. Experience in these areas indicates that any entity dealing with this population must be prepared to devote considerably more time and resources to providing this group with information. For example, materials must be tailored to retirees to ensure that they can understand the information being conveyed. This includes printing materials in larger type and often targeting written materials to the appropriate reading level.

Multiple communications vehicles are necessary for this group, including open enrollment sessions, videotapes, toll-free telephone numbers, mailings, presentations, and one-on-one meetings. Other tools such as up-to-date directories listing the primary care physicians participating in a plan and plan options are also helpful.

9  

The material in this section is based on remarks by Kathleen P. Burek and Barbara L. Decker.



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