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April 13, 2006

Pitt needs consumer advocate for health plan, Assembly says

Should Pitt and the UPMC Health Plan name a consumer advocate for Pitt employees?

Faculty Assembly believes so.

Last week Assembly voted unanimously to accept the report of an ad hoc committee, chaired by health law professor Nathan Hershey, on consumer satisfaction with UPMC.

The committee was appointed to follow up on concerns raised at a March 2005 Senate plenary session on that subject that Hershey moderated.

The ad hoc committee report recommended establishing a comprehensive and systemic consumer advocate mechanism “staffed by an individual or individuals, whose primary, if not sole, duty is to represent and assert the interests of beneficiaries.”

The report further recommended that Pitt require UPMC to designate individuals in each of its organizations to whom the consumer advocate should direct problems or questions about the provision of services, payment and coverage eligibility. The consumer advocate should report annually to Faculty Assembly to summarize the nature and volume of efforts undertaken on behalf of employees and their families, the committee also urged.

Hershey noted that the UPMC Health Plan is not an insurance plan in the traditional sense. “Heath benefits for University employees are paid for by the University, which contracts with UPMC Health Plan to administer the benefits program,” Hershey said. “The University provides funds to the plan to pay providers and to pay for administrative services pursuant to the contract” between Pitt and the plan, while employees have amounts deducted from their paychecks as contributions, he said.

Hershey’s committee found two broad categories of problems encountered by health plan beneficiaries. One area involves knowing what services are covered by the health plan contract and whether bills are correct. The second, he said, regards problems such as access to services, quality of services and appointment scheduling.

The ad hoc committee also recommended that Pitt, as UPMC Health Plan’s largest client, have representation on any UPMC consumer advisory group. “The University [should] insist that at least one University employee who does not hold a high-level managerial position serve as a member of any UPMC consumer advisory group that advises with respect to benefits or services,” Hershey said, reading from the committee report.

The committee urged the University Senate executive committee to pass on the recommendations to Pitt’s central administration for implementation, a recommendation endorsed by Faculty Assembly.

The two-pronged goal of these recommendations, Hershey added, is to solve problems promptly and to ensure that the relevant UPMC entity takes action to prevent the problems from recurring.

Not only problems and gripes are at stake, Assembly members noted. “It’s more than grievances; it could be concerns, questions, even asking directions,” Herbert Chesler said.

As a rule, people are too docile to raise health benefits issues, Hershey said. “Plan participants need to be more assertive, to challenge co-pays if they think they’re incorrect, to speak up about scheduling outrages.” The passiveness of participants in the health plan is costly, he added, because problems persist when they are not brought to light. A dedicated consumer advocate, armed with UPMC contacts and a repository of information on consumer difficulties, could alleviate that problem, Hershey said.

The report did not specify whether such an advocate should be an employee of Pitt, of UPMC, of both or of neither, leaving that detail for future negotiations between Pitt and UPMC.

Also at the April 4 meeting, Faculty Assembly heard a report from the Senate benefits and welfare committee, co-chaired by Chesler.

“Our committee was asked a while back how to proceed with regard to smoking in areas near building entrances,” Chesler said. “I think we’ve come up with a clever approach. There is no attempt to change policies and we’re not attacking smokers.”

The committee instead is experimenting at a limited number of entrances to Pitt buildings to see if “courtesy signs” — asking smokers to move a respectable distance away from high-trafficked areas — would have an effect on smokers’ behavior.

So far, placards have been installed near the entrances to Posvar Hall, the Barco Law Building and Victoria Hall, Chesler said. Those buildings were picked so committee members could do spot checks on their respective building entrances, he said. “We’re not doing this all over the University. We’re doing it quietly, with no controversy, and there’s no enforcement. I think the committee’s sense is that we’re encouraged,” Chesler said.

He asked Assembly members for feedback on the concept and to recommend potential other entranceways around campus for the courtesy signs.

—Peter Hart

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