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| Health Alliance Medical Plans: A Step Beyond |
| Insurance | |
| Written by Amanda Gaines | |
| Tuesday, 01 January 2008 | |
 Jeff Ingrum and his executive team took this health insurance company to the next level by balancing quality, service, and cost.
Health Alliance began in 1980 as a not-for-profit health plan under the name of Carle Care, reflecting the name of its provider sponsor. Although the Illinois-based company decided to change its name and create a separate identity for the health plan in 1989, Carle Clinic continues to be the owner and one of Health Alliance’s largest clients and is a contributor to and a benefactor of the health plan maintaining excellent accreditation with NCQA.  Jeff Ingrum, President and CEO Health Alliance’s key provider networks are centered on multi-specialty clinics. Carle Clinic, for example, comprises roughly 340 physicians. Springfield Clinic in Springfield, Ill., another major client, comprises between 180 and 200 physicians. “The dynamics of those medical groups—the administrative structures and commitment to quality—made it easy to incorporate the NCQA processes and programs,” said Ingrum. “The cooperation we’ve received from those physicians has enabled us to achieve that high level of performance.” Because Health Alliance is owned by a large physician group practice, the company understands the need to include physicians in the policy decisionmaking, as well as finding ways to keep costs low. Infrastructural efficiencies enable Health Alliance to keep its administrative costs down while investing money back into the company. Consequently, physicians put their trust in Health Alliance and strive to perform to the best of their ability. “Working in conjunction with our key partners to deliver value, we have significantly enhanced the quality of care that our members receive,” said Ingrum. “Our excellent accreditation only illustrates that by working as a team, we are in fact improving the services we provide to our members.” Take it up a notch As the company has incorporated NCQA standards into its processes, it also adopted InterQual treatment guidelines and provided them to physicians. In 2001, Health Alliance purchased McKesson’s medical management tool, which has InterQual guidelines embedded. Physicians could now access and integrate the NCQA goals with InterQual principles. In 2006, the executive team at Health Alliance took the company to another level by developing a long-term strategic plan to redesign IT functionalities and improve accessibility to enrollees. “We’d been on a legacy managed care system platform and hadn’t upgraded since 1993,” said Ingrum. “It was a good system for a small to mid-sized managed care plan, but after 13 years, we realized we needed an open-architecture platform with Web-based capabilities.” Health Alliance’s broad product line, including fully insured HMO and PPO plans for groups and individuals; POS and Medicare PFFS plans for groups; Medicare HMO, PPO, and Supplement; and self-funded plans, made having a flexible IT partner a priority, not an option. After a six-month evaluation process, the company chose TriZetto Group’s managed care system. “The flexibility, open architecture, strength of its claims processing system, and flexible benefit design configurations led us to believe that, as we looked to the future, this system would provide us the flexibility and leading edge technology we would need to compete with some of the larger insurance companies while providing the kind of robust technology we’d need to interact with consumers in the future,” said Ingrum. The TriZetto system includes a program called Model Office, through which Health Alliance employees can model out new benefit designs, programs, and processes to test plausibility before rolling out company-wide. If all goes as planned, Model Office will enable Health Alliance to develop products and work out modifications at a faster pace, creating a higher level of value for customers. “This is a new opportunity for us to do more R&D, which is something we never had the capability to do efficiently or effectively,” said Ingrum. “By researching programs and benefits for our employer customers, we can be market leaders and enhance our offerings to employers.” Keeping the pace Although the biggest visible change in the company may be its IT upgrade, the largest fundamental change will be how the culture of Health Alliance will keep up. In addition to a new system design, including how employer groups are enrolled and their benefits administered, employees will play a different role in the development of the company. To address that needed culture change, the Health Alliance management team has undertaken a leadership development project.
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