This Texas health plan wants to become recognized as the best in the nation. Allan Einboden tells Michael Sharkey how this vision will become reality.

The best health plan in Texas isn’t kicking its cowboy boots up just yet. In 2005 and 2006, US News & World Report ranked Scott & White Health Plan the number one health plan in the Lone Star State. But according to executive director Allan Einboden, the team at the Temple, Texas-based organization won’t be satisfied until Scott & White Health Plan is recognized as the most trusted and valued health plan in America.

Allan Einboden

It’s a lofty goal, but one Scott & White Health Plan is already well on its way to achieving. The US News & World Report study compared more than 260 commercial health plans covering 61 million people nationwide. Scott & White Health Plan ranked 78th among commercial plans and 13th among Medicare plans, with an overall score of 88.6 out of 100 possible points (based on access to care, overall member satisfaction, prevention, and treatment).

The health plan also received an AM Best rating of A- following an extensive review of its financial strength and operating performance, earned the highest rating on efficiency and helpfulness in customer service from the Office Public Insurance Counsel, and received one of the counsel’s lowest patient and provider complaint ratios in Texas. Further, in 2006 the National Committee For Quality Assurance (NCQA) awarded Scott & White Health Plan with an Excellent Accreditation for the third consecutive time. According to NCQA, an Excellent Accreditation is only awarded to health plans whose service and clinical quality meet or exceed rigorous requirements for consumer protection and quality improvement.

“Earning Excellent Accreditation reflects a health plan’s ability to work with its members and physicians to improve the quality of clinical care,” said NCQA president Margaret O’Kane. “It shows that the plan is building the kinds of partnerships that are critical to delivering great care and great service.”

Core mission
The core of Scott & White Health Plan’s success lies in its history. In the late 1970s, physicians at Scott & White Hospital had the novel idea to combine the well-respected institution with a practical, efficient system of pre-paid healthcare. On January 1, 1982, the health plan began operation by signing up Scott & White employees.

Today, $500 million Scott & White Health Plan has grown to cover 34 counties and 200,000 members, but its original mission has not changed—to provide personalized, comprehensive, high-quality healthcare, enhanced by medical education and research.

“We were founded by physicians, and physicians still lead in all activities of the health plan,” Einboden said. “We have key care delivery individuals involved in everything that we’re doing. They understand the care delivery process and the needs of individuals that are receiving care, and they can help educate administrators like myself about the complicating factors that need consideration.”

The companion piece to Scott & White Health Plan’s success is its focus on the patient. According to Einboden, the culture of the organization is much like the culture of Central Texas. Employees of the organization are exceptionally friendly and treat every member they deal with like family. “It’s as benevolent an organization as I’ve ever worked with,” he said. “There are no self interests, people are only interested in how we can serve the patient and improve healthcare.”

Providing value
Treating members of the health plan like family goes a long way in improving customer satisfaction, but it wouldn’t mean much if Scott & White Health Plan didn’t have the right coverage at the right price. According to Einboden, that’s why the company works overtime to provide healthcare solutions based on each customer’s specific needs.

Sales representatives are trained to work with businesses in a collaborative manner, engaging them in discussions about the challenges they face and how Scott & White Health Plan can help overcome them. Account managers then work with clients throughout the year to keep them updated on the latest trends in the industry, and develop timely plans that meet their latest needs.

“We don’t just offer cookie cutter type plans. We listen to our customers and we offer flexibility so employers can pick various types of benefits,” Einboden said. “In turn, employees can pick the plans that best suit them.”

And if there is a problem or issue that needs to be addressed, members can quickly and easily contact customer service. There is no automated system, full of recordings and confusing options, to navigate; a live person answers the phone in less than 30 seconds, on average. If the customer prefers to speak with someone in person, they can go to one of Scott & White Health Plan’s four offices and sit down with a representative. And for those with difficult schedules, there is always the company’s Web site, chock full of information 24 hours a day.

“We do believe in automation,” Einboden said. “Anything we can automate that is not customer facing, we will. But when it comes to the customer, we want to provide the best service where they want it when they want it. However they want to access us, online, in person, or over the phone, we’ll take care of them.”

As evidenced by the recognition it has received nationally and in the state of Texas, Scott & White Health Plan’s formula of a health system integrated, patient friendly health plan is working. And Einboden believes this formula will help the company fulfill its vision—to become the best health plan in America.

“It all comes down to delivering a valuable, quality product,” he said. “That’s something many plans claim, but it’s something we’re recognized for. We’re in the top tier in senior care now, and we’re working to move into the top tier in commercial care. And we won’t be satisfied until we’re at the very top in both categories.”