Country's top HMO reveals trade secrets

MANILA, Philippines - “Heaven can’t be reached in a single bounce,” so the saying goes. But fully Filipino firm IntelliCare seems to have done just that, skyrocketing from the bottom to the top of the heap in less than 15 years.

How IntelliCare has done it has been an intriguing industry question since many similar health maintenance organizations (HMOs) have since collapsed along the way. Yet, IntelliCare now leads the HMO industry with its over 1,000 corporate accounts composed of leading companies in every sector, total membership of almost 600,000, a network of more than 12,000 of the country’s well-known physicians and medical specialists, and almost 800 reputable hospitals, clinics, diagnostic centers and other first-class medical institutions.

The company now also has a vast asset base expanding to over P1 billion, a dynamic workforce of nearly 800, and growing financial muscle of over P200 million in stockholders’ equity from only P1.9 million in 1995.

These numbers speak of economies of scale that IntelliCare has amazingly attained in just a little over a decade, and still counting, fast.

For all these incredible feats, chairman and president Mario Angelo M. Silos has a lot of drum beating to do, especially to IntelliCare’s shareholders in the company’s forthcoming 15th anniversary in November this year.

This early, though, Silos has agreed to shed light on the company’s stunning but pleasantly surprising success.

“Our success is remarkable given the odds we had to hurdle. But silently and steadily we’ve overcome them and grown at a pace we hardly thought possible,” Silos recalled.

“We attribute that growth primarily to our focus on customers and the quality of our service, as attested to by a 90-percent retention rate of business, with new sales growing at no less than 30 percent on average per annum. This translated to a membership expansion from an initial base of 3,000 in 1996 to almost 600,000 this year.”

That period of growth also covered certain paradigm shifts in the HMO market, which could be attributed in a large part to IntelliCare.

“One is the dramatic growth of TPA (Third Party Administration) business. This component of the HMO business was insignificant 15 years ago. But IntelliCare, recognizing its (TPA’s) huge potential, shifted marketing focus from the regular HMO product. Today, TPA business for IntelliCare covers 40 percent of its membership base  the biggest ratio in the HMO industry, with that of almost other HMOs having only 10 percent or less of their total business,” Silos explained.

Under the TPA program, corporate clients deposit on behalf of their enrolled members a fixed amount to a “health fund” that is administered and exclusively used by IntelliCare to pay for the healthcare services and benefits that clients have availed themselves of. Under this arrangement, therefore, clients only pay for the amount actually utilized.

The health fund is then replenished regularly by clients to keep it within the pre-agreed amount  usually three months’ worth of utilization costs. IntelliCare charges against the fund its administrative and network access fees and other medical collectibles on services/benefits not covered by or in excess of the pre-agreed limits.

Upon maturity date of the TPA health plan contract, the remaining balance of the fund is remitted back to clients, net of all charges.

Thus, the TPA program relieves clients of financial pressures. Because instead of paying a fixed periodic premium, clients pay for only what has been actually utilized by their employees. The clients are also able to enjoy IntelliCare’s volume discounts on medical charges in view of its large collective base of enrolled members. But over and above these benefits, the clients are afforded equal access to IntelliCare’s top-rate, countrywide infrastructure for effective and efficient healthcare delivery, at no extra cost.

On the other hand, IntelliCare’s HMO Benefit Program covers an annual physical exam (APE), preventive and outpatient medical services, inpatient confinement, and emergency care.

Together, IntelliCare’s HMO Benefit Program, TPA and other services constitute a comprehensive coverage of clients’ various healthcare requirements.

“This holistic approach to healthcare management is the value that we always aspire to create. This covers preventive, treatment (curative), and management of health, including monitoring and reportorial services,” Silos said.

As a corporate matter, this approach provides an organization’s employees with a strong sense of security, boosts their confidence and morale, reduces absenteeism and tardiness, improves their productivity and performance on the job, increases a company’s output and margins, and adds value to the entire business operation.

“Indeed, the customer is the center of our world. That is the motto of IntelliCare. The customer is our benchmark. So we keep asking, ‘What does he want?’ The only way we can do this is to be always in touch with him. For example, we have a 24/7 call center to assist our clients. We also have more PROs (patient relations officers) in tertiary hospitals than the competition, for us to always be there as and when needed. We also put up multi-specialty clinics  with laboratories, x-rays, etc.  at accessible locations for the ease of members to have their APE, regular checkup or immediate medical attention for any health problems, thus cutting costs.

“At the end of it, the major issue to be resolved is cost-efficiencies and cost-containment. The major elements to this will be the type of health benefits each organization has decided upon. But the foundation will always be the current health condition of its members.

“A preventive program is essential to either prevent the onset of disease or to manage and control existing ones. Second is to provide access to facilities with proven track records of cost-efficiencies. Third is to emphasize that the benefits must cover needs and not wants.

“From a healthcare issue previously handled merely by the human resource department, the cost of healthcare has thus escalated to a level of significance that top management is now involved in the intricate process of decision-making.

“In our 15th-year celebration this November, we will honor our partners  these are the doctors, hospitals and clinics, brokers, agents, member-corporate accounts and our people  in totality, the IntelliCare family. We have deemed all as heroes for they have been instrumental in creating IntelliCare as it is today  a market leader, innovator and trailblazer par excellence.

“So, to us in IntelliCare, there’s simply no substitute for value, and no better sense of fulfillment than having happy and satisfied customers. In a nutshell, these customers are IntelliCare’s highly cherished trade secrets, the key to our growth and industry leadership,” Silos concluded.