New West Health Service: Freedom to Choose - Health Executive - RedCoat Publishing - Inside Healthcare

When it comes to making choices about health insurance, most of us have a pretty easy choice. That’s because we essentially have no choice at all. People are forced to take the plan available through an employer or spouse, and if that isn’t an option, they buy the best individual plan they can afford. For about 16% of Americans, that means no insurance whatsoever. Montana’s New West Health Services is hoping to give Treasure State residents options beyond “overpay” and “go without.”

David Kibbe, CEO

“We have a fundamental belief that healthcare is too complex, and a lot of health insurers have been part of the problem,” said CEO David Kibbe. “We see ourselves as a catalyst for change in terms of simplifying healthcare coverage and connecting people to good healthcare.”

New West is the second largest domestic health services organization in Montana. The organization has headquarters in the capital of Helena, a large operations center in Kalispell, and two regional offices in Billings and Missoula.

The company got its start in 1998 and has since forged partnerships with more than 1,400 medical providers. It now has 41,000 members from 1,000 individual businesses. New West offers individual and group plans, Medicare Advantage individual and group coverage, and a Federal Employee Health Benefits Program through independent insurance agents around the state.

Synergy search
New West is owned by six community-based hospitals: Billings Clinic, Community Medical Center, St. Peter’s Hospital, Northern Montana Health Care, Bozeman Deaconess Hospital, and Benefis Healthcare. Technically, the hospitals are members of the New West health services corporation. The relationship between New West and its sponsor hospitals is beneficial to all parties, Kibbe said, but it is challenging at times to use common ground in healthcare to forge a strong common mission in New West.

“They have a common interest to improve the access, quality, and affordability of healthcare and work together well in many respects, but they operate in different markets and different communities. They have different competitors and missions,” he said. “For example, Billings Clinic is a major, multi-specialty integrated group practice. The other hospitals have some physicians who work for them but rely much more on an independent medical staff for admissions. So we try to knit together the similarities that exist.”

Part of finding that common ground for Kibbe involves a shift in culture within New West itself. With multiple hospital owners, he said, it was easier to develop health plan approaches and products designed to accommodate each hospital. The problem, however, was it became difficult to develop an overriding plan on New West’s approach to the market in general. Instead, plans were focused more on responding to the organization’s hospital owners.

“We needed to create an outward market focus because of the importance of our customers, both existing and prospective. We have employers, individuals, agents, providers, and regulators that are all customers in different forms,” Kibbe said. “So we put together a comprehensive plan with action items and performance metrics to guide our development and execution, and we hold individuals and teams accountable for results.”

New West also rewards people for success. Part of protecting its future is through incentives for positive results so quality employees will stay on board long-term. Key contributor bonuses recognize outstanding employee efforts, and all employees benefit from a gain sharing program when membership, customer service, and financial targets are met and exceeded. Kibbe thinks these factors help improve internal alignment and make New West function more like a team rather than co-workers simply sharing space.

Keep it simple
The organization recently reinvested in its IT tools to improve internal operational functions. New West has been using the Perot Systems Diamond 950 application to provide accurate data and improve workflow processes, but the system was not set up well originally. New West was challenged with inefficiency and overcame early problems to deliver services to customers. But the company liked its third-party vendor and partner, Perot Systems, and early this year decided to migrate to Perot’s Peradigm solution in expectation of improved information, efficiency, and service in its core applications of claims, premium billing, enrollment, and customer service.

“That is an $11 million contract and a sizeable upfront commitment. Now with the core system decision made, we will be making investments in ‘wrap around’ subsystems,” said Kibbe. “We’re looking at customer relationship management (CRM), complete care management systems, and Web portals with self-service capabilities for agents, providers, and employers for implementation in the near future.”

An added bonus of investment in the new systems, Kibbe believes, is an opportunity to reach the company goal of simplifying healthcare while improving customer service. By upgrading to the Peradigm system, the company made a conscious choice to maintain customer service operations locally in Montana. Live voices answer phones and are highly versed in the details of all New West products and services. To simplify its product line, the systems will allow the organization to conduct a thorough review of all its offerings and processes.

“Like many health insurers, we have products and benefits that are too complex. We who live and breathe it every day struggle at times to understand the co-insurance, deductibles, stop losses, and out of pocket maximums,” said Kibbe. “We are doing a comprehensive review of our products and services, simplifying them with an eye always on our mission of connecting people to good healthcare in a simplified way.”

Behind all of this is a company commitment to provide people with health information when it is needed the most. Kibbe said most people don’t look for information about health issues until they think they really need it. Often, that information comes too late. Through simpler internal processes and products, improvements in customer service, and industry partnerships, New West hopes to share appropriate information with customers on preventive and wellness programs to help improve people’s health before major treatments are necessary.

“We are starting to ask questions about how we pay for services,” Kibbe said. “We are looking at paying for value, cooperation, and outcomes, rather than simply paying for more delivered services. We need to get everyone involved in discussing good patient care rather than managing as a smaller health insurance bureaucracy.”

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