Evaluating Managed Care Proposals: Site Visits

Once the plan sponsor has narrowed down potential vendors based on an evaluation of the proposal responses to the RFP, visits to the sites of the finalists' operations are recommended to further verify the written materials and to meet the staff responsible for operating the health plan. Agendas for such meetings vary, although it is common for the plan sponsor to list specific areas they wish to discuss during the visit. Most site visits will seek to at least interview and question those health plan personnel who will service the business. It is also common for the bidding company to demonstrate the computer systems that are used to support its business, including claims administration, member services, UM protocol programs, and other medical management information systems.

Because there are often expert staff from different areas of the bidding company present at the site, it is advisable for the plan sponsor to consider bringing individuals who have the appropriate expertise to ask the necessary questions and understand the operation. Preparation is important in this phase, and the consultant should help the plan sponsor establish objectives for the site visit and conduct a post-visit debriefing to make sure all outstanding issues and questions have been addressed. For plan sponsors with multiple locations, it may be appropriate to conduct site visits in each of the principle locations because health plan management and operation may vary from site to site.

In addition to the site visit, the plan sponsor may wish to consider contacting current customers of the bidding companies to assess references. Employer and employee satisfaction of managed care will be largely affected by the ability of the managed care company to follow through on commitments and meet the objectives of the plan sponsor. HEDIS reports provide one means of plan comparisons for plan sponsors. While surveys show members are generally satisfied with managed care, satisfaction rates will vary among different managed care plans.