Health Partners Case Study

Health Partners Plans (HPP) is a Managed Care Organization, providing low income individuals health care through its Medicare, Medicaid and CHIP lines of business. It is a relatively small MCO, serving just over 240,000 Medicaid members and has just reached the 20,000 member mark for Medicare. Though small in size, it performs fairly well against other health plans in the market and has recently been granted access to expand its services into other regions and eventually, states. Though competitive, it will need improvement, and senior level encouragement, in the next few years to emerge as a true analytical competitor. In comparison with other companies in the market, Health Partners has not yet reached its full potential in terms of

The information technology staff maintains data tables and warehouses, providing relatively clean data to the company. Policies, processes and procedures are clearly documented and management has done a fairly decent job of ensuring transparency within the organization so that employees know the functions of other departments, what data they work with or impact and what the data means. Management does its best to perform frequently analyses of the data and regularly informs staff when either updates have been made or issues have been encountered. Distinctive capabilities and some level of competitive advantage are features of stage 1 and stage 2 companies. HPP has been able to solidify a competitive advantage in the health insurance market through its commitment to surpassing customer expectations and delivering outstanding care and support. In the Medicaid line of business, HPP has been rated “#1 in Member Satisfaction with Plan” for Health Choices in Southeast Pennsylvania in the last few years, which sets HPP apart from competitors. HPP has also managed to build a strong model of care to respect and support cultural diversity, earning 4 NCQA Multicultural Health Care Distinction awards from 2011 to 2017. These are defining capabilities that also portray HPP’s mastery of stage 1 in analytical

The Provider Analytics group and senior management partake in Joint Operating Committees (J.O.C. meetings) and workgroups which are held to allow hospital representatives the opportunity to ask questions, suggest new ideas and programs and discuss the overall implications of the information they receive from HPP. High-levl summaries are provided quarterly which highlighted each owner’s or provider’s financial status, member behavior and other important topics. These reports serve a similar purpose to that of the “scorecards” that Davenport and Harris (2007) briefly discuss. Scorecards and performance management processes are described as, “obviously important to managing any business and [they’re] increasingly important to keeping senior executives out of jail” (Davenport and Harris, 2007, p. 60). HPP and individual shareholders may have different goals and expectations, but this collaborative relationship between the two guarantees that special interests and important issues are discussed and record. Considering the ever-changing and unstable nature of health care, these reports and meetings are valuable to both entities. More importantly, they ensure that the proper steps are taken so that all parties can meet or hopefully exceed