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Group Health Cooperative offers refunds to unsatisfied patients

August 30, 2018
Group Health Cooperative offers refunds to unsatisfied patients

Hannah Tunney, 2, holds a book while getting a check-up in 2016 from nurse practitioner Francesca Vash at Group Health Cooperative of South Central Wisconsin.

Group Health Cooperative of South Central Wisconsin is offering refunds to patients not happy with its service, becoming one of only a few health-care providers nationally to issue a money-back guarantee.

Group Health’s Experience Guarantee program, to start Friday, will refund up to $2,000 in out-of-pocket costs if patients believe they waited too long, felt staff were unfriendly or thought doctors communicated poorly, among other service-related complaints, said Dr. Mark Huth, CEO.

“It’s our expectation that you’re going to have a fantastic experience with all of the staff and all of the things you do in our clinic,” Huth said. “If we didn’t do that, we’ll make it right. If we can’t make it right, we’ll offer you a refund.”

The program is modeled after one at Pennsylvania-based Geisinger Health System, which started offering refunds to some unsatisfied patients in 2015 and expanded the effort in 2016. Dr. Jonathan Slotkin, a leader of the program at Geisinger, said Group Health in Madison appears to be only the second health system to launch such a program. An undisclosed insurance company recently started letting providers offer refunds if they wish, he said.

Geisinger has refunded $1 million for complaints about construction noise, long waits to get appointments and untimely access to test results, feedback that has improved the organization, Slotkin said. It receives about 100 refund requests a month, with an average refund given of $265.

“Our patients put enormous trust in us, so we need to put trust in our patients,” Slotkin said.

Group Health’s refund program could spur other providers in Wisconsin to focus more on patient experience, said Cheryl DeMars, CEO of The Alliance, a Madison-based group of about 240 self-insured employers that purchase health care together.

“They’re putting themselves at risk to satisfy their patients,” she said. “That’s a good thing.”

Rachel Grob, director of national initiatives at UW-Madison’s Center for Patient Partnerships, said Group Health’s effort should help patients feel more respected.

“The caring in health care is often what our system tends to do least well,” Grob said. “The more that trust and confidence is placed in patients from the health system and the people who provide care, the more responsible and empowered patients are.”

Group Health’s refund program won’t cover disagreements over a doctor’s medical decisions or whether particular drugs or treatments should be covered, Huth said. For example, patients who want antibiotics for viral illnesses, but don’t receive them, won’t qualify, he said.

Medical errors or side-effects from medications and procedures generally won’t qualify unless poor communication by a provider was involved, Huth said.

For service-related complaints, Group Health will let patients determine what degree of problem deserves a refund and what the amount should be, he said. The refunds are for out-of-pocket costs, meaning co-payments and deductibles.

The health system won’t require proof that a provider’s behavior was inappropriate or a wait was too long, Huth said.

“We’ll trust the member’s report and offer the refund if they feel it’s appropriate,” he said. “We’re going to let people set the bar.”

He acknowledged the no-questions-asked approach will bring Group Health “exposure.”

But Slotkin said there has been minimal abuse of the program by patients at Geisinger, a health system that is larger than Group Health and has hospitals, which Group Health doesn’t.

Grob said she doesn’t think patients will misuse Group Health’s program. “I think it will make people more kindly disposed to the system,” she said.

Huth said Group Health has long made gift cards available to patients with on-the-spot concerns. The new program will ask patients to explain refund requests through an online app or by phone, which should allow the organization to gather more data on how it can improve, he said.

“This strengthens the consumer’s voice,” he said. “It further will help separate us from an already competitive market.”

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