By significant margins, enrollees, purchasers, and physicians are satisfied with their participation in triple-option, point-of-service health benefit plans, according to findings of six separate studies of programs in Baltimore and Cleveland.

The studies were conducted over two years for Novalis Corporation by Fact Finders, Inc., an Albany, New York-based independent research firm. Novalis Corporation is a supplier of information, consulting support, and integrated technology to managed care organizations.

Major study findings published in a new Novalis/Fact Finders report, "Determinants of Enrollee, Purchaser, and Physician Satisfaction with Point-of-Service Plans," include:

  • Nine in ten enrollees say they are satisfied with the point-of-service plan and seven in ten would recommend it to others.
  • Eight in ten enrollees report that the plan is easy to understand.
  • Eight in ten enrollee households report using in-network services through their primary care physicians.
  • Fewer than two in ten enrollees use any out-of-network services and virtually no one reports using out-of-network services exclusively.
  • Having to change primary care physicians as a result of entering the point-of-service plan has no effect on enrollee satisfaction.
  • Enrollee satisfaction is determined by the number of visits made to their primary care physicians (PCPs), the positive ratings give to their PCPs, and their use of in-network services (rather than their freedom to "opt out").
  • Virtually all purchasers rate the triple-option, point-of-service design as "good" or "excellent." Ninety-six percent of purchasers report that they are satisfied with the plan and would recommend it to others.
  • Nearly nine in ten purchasers say they intend to renew the point-of-service plan.
  • Seven in ten purchasers report that price, the plan's potential for cost control, and the quality of its physician network are the factors which greatly influence their decision to offer point of service.
  • Employers attribute more freedom to the point-of-service plan than enrollees.
  • Nine in ten primary care physicians report satisfaction with the plan. However, there is some variation in satisfaction among the primary care specialties.
  • Primary care physician satisfaction with the point-of-service plan is correlated with the number of patients they have in the plan and is inde-pendent of the compensation they receive.

The Novalis/FactFinders report presents findings from three enrollee studies, two purchaser studies, and one physician study conducted in Baltimore at Preferred Health Network of Maryland, Inc. (FlexChoice) and in Cleveland at QualChoice, Inc.

During 1991 and 1992,750 enrollees in the Baltimore plan were interviewed in a scientific probability sampling design. In 1992, a similar study of 350 enrollees in the Cleveland plan was also conducted. In addition, a census of purchasers in the Baltimore plan was conducted in both years, and a random sample of network primary care physicians was conducted in 1992.

These surveys are a part of a multi-year, multi-site Novalis study of these populations in order to better understand the attitudes and behavior of participants in the triple-option point-of-service model.

In each of the plans, a "fused" triple-option, point-of-service benefit design was studied. This design integrates features of HMOs, preferred provider organizations (PPOs), and traditional indemnity insurance into a single program intended to replace all other health benefit offerings.

Under the design, enrollees choose one of three options at the point the need health care services. They may choose to go through their primary care physician, go directly to another member of the plan's provider network, or go outside the plan's network of participating providers. Services authorized by or rendered by primary care physicians carry the least out-of-pocket expense to enrollees, while out-of-network services require the greatest enrollee cost sharing through higher deductible and coinsurance payments


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