News

Excising mystery from health care
Patient Care helps clients' employees
By Guy Boulton of the Journal Sentinel
Posted: Dec. 28, 2008

Jane Cooper's timing when she founded Patient Care was at once exceptional and terrible.

Patient Care, which helps people navigate the health system, was started in August 2001, a few years before high-deductible health plans became more common and more costs were shifted to employees.

But the company also was founded a month before the Sept. 11 terrorist attacks and just as the economy was entering a recession - rarely an auspicious time to start a business. Patient Care persevered and began making headway. Then Hurricane Katrina hit.

Patient Care at the time was based in New Orleans. Its offices were on Canal St. near the Superdome.

"The company survived two of the biggest disasters in the country's history," Cooper said.

Cooper, who grew up in Waukesha, moved the company to Milwaukee after the flood and, with some key employees, began rebuilding.

Patient Care now has 200 clients throughout the country, employs more than 30 people and has revenue of about $5 million a year.

Companies hire Patient Care, what is known as a health advocate, to handle many of the tasks that can overwhelm human resource departments, such as employees' questions about coverage, networks, unpaid claims and other intricacies of the health care system.

Its customers in the Milwaukee area include Briggs & Stratton Corp., Midwest Airlines, Bucyrus International Inc., Badger Meter Inc., Harley-Davidson Inc. and Associated Banc-Corp.

Navigating the system

Patient Care was an outgrowth of brainstorming sessions with some of Cooper's colleagues and friends.
"The idea we kept coming back to was the average consumer really struggles with navigating the health-care system," Cooper said.

Here is where her timing was exceptional. Health insurance premiums would increase at double-digit rates for the next several years. Health savings accounts also were about to be introduced. Both would lead to health plans with high deductibles becoming more common, making people even more likely to need help understanding their medical bills and the details of their health plans.

Just trying to resolve an unpaid claim can take weeks. And those calls typically have to be made during the work day.

"These guys specialize in this," said Sherri Ehleiter, manager of compensation and benefits at Midwest Airlines. "They do it every day."

They also know who to call when a problem comes up.

"With the employee's authorization, they pretty much can do all the legwork," Ehleiter said.

In addition, few human resource departments these days have the people to field those questions. And companies must be wary of violating the federal law on patient confidentiality.

Patient Care typically charges companies $2.50 to $3 a month for each employee. Larger companies pay less.

Its customers have an average of about 400 employees each, Cooper said. Some are much bigger, but many customers are small employers, who don't have human resources departments.

The company employs about 30 advocates, who generally earn $30,000 to $40,000 a year. The firm looks for people with a background in insurance and good people skills.

"If calling us is like calling the insurance company, we are in trouble," Cooper said.

Information on quality

Patient Care also will give estimates on the potential cost of a procedure. In most cases, they are only rough estimates because the rates that health plans negotiate with hospitals and doctors are confidential.

The company sometimes is given the negotiated rates, Cooper said. And some health plans, such as Humana and Anthem Blue Cross and Blue Shield in the Milwaukee area, are providing price comparisons for different hospitals and doctors.

Patient Care also will provide people with information on quality.

Cooper estimates that about 6% of Patient Care's calls are from people seeking information on prices or quality. Still, that's roughly double the percentage in 2007.

The company's largest competitor is Health Advocate Inc., based in West Conshohocken, Pa., a Philadelphia suburb. CareCounsel LLC, based in San Rafael, Calif., is another competitor.

Patient Care doesn't pay commissions to brokers but will pitch Patient Care as a service to their clients.

Cooper is confident that Patient Care, which has raised roughly $2 million from 22 investors, can grow 25% a year. Fidelity National Financial, a title insurance and escrow company with 10,000 employees, for example, will become a customer next month.

The economy is a concern. And finding sales people and advocates is a challenge. So, too, is keeping the data simple, which is never an easy task in health care. Still, those challenges are minor compared with surviving a natural disaster.