AmeriHealth New Jersey: Judith Roman, President/CEO

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Founded in 1995, AmeriHealth New Jersey is a state-based health-insurance provider whose mission is to help its customers and members maximize wellness in every conceivable way.

Unlike many other providers throughout the country, AmeriHealth New Jersey concentrates on one area—New Jersey. Together with its affiliate, AmeriHealth Administrators, AmeriHealth New Jersey insures 210,000 people in the state.

Concentrated focus, wide in scope

According to Judith Roman, president and CEO of AmeriHealth New Jersey, the organization is the only statewide health insurer focused exclusively on serving New Jersey customers.

“We are a New Jersey-based organization focused solely on the needs of New Jersey-based businesses and public entities,” Roman said.

AmeriHealth New Jersey places a strong emphasis on small and medium-sized organizations in the state, specifically employer groups with 51 to 500 employees. Unlike many insurance carriers who have to battle the regulations of multiple states, Roman said AmeriHealth New Jersey can focus on New Jersey employers and regulators with “our undivided attention,” thus allowing the organization to help shape the future of New Jersey healthcare.

Because its attention is focused on New Jersey, Roman said AmeriHealth New Jersey’s growth formula is more specific and revolves around finding the right product mix, maximizing customer satisfaction, and strengthening broker relationships.

“We can actually pay more attention to developing the type of product that the New Jersey customer is demanding or that the mid-sized customer with 51 to 500 employees is demanding,” Roman stated. “And we can do that with a specific, exclusive focus because we’re concentrating on one market.”

Blazing an innovative path

AmeriHealth New Jersey’s exclusive focus on the state of New Jersey has become more beneficial with the passage of healthcare reform. Roman said the organization is committed to helping its customers understand the ramifications of reform and make the best choices for their organizations.

“We understand that folks need to have access to health insurance and that many of the specific questions about the healthcare-reform legislation at some level remain undefined, and we don’t have all of the answers ─ no one does,” Roman said.

Roman added that she wants AmeriHealth New Jersey to be a resource for customers and members on the newest mandates, so that when employers have decisions to make, they can consult her organization with confidence. Roman believes that forging relationships with the right people in government is key to developing expertise that can benefit AmeriHealth New Jersey’s clients.

“We have partnered with our state legislators and regulators so that we work together to shape the future course, because many of the decisions will be left up to the state,” Roman said. “It’s a federal healthcare-reform bill, but a lot of the execution will be at the state level.”

Roman boils the purpose behind reform down to three specific areas—quality, accessibility, and affordability.

Reform: Making sense of it all

As the debate regarding healthcare reform escalated, insurance providers often bore the brunt of public and political outrage. Roman feels this is a matter of misperception.

“What I think is misunderstood by the average consumer about health-insurance premiums is that 87 cents on every dollar that’s collected in premiums pays medical claims,” Roman explained. “At the end of the day, a company like AmeriHealth is working on approximately a two-percent margin and an 11-percent administrative cost.

“So if you take that dollar and you’re spending 87 cents to pay the medical claims that come in from the doctors and the hospitals and other medical providers and you have about two percent that is profit, you’re at just under 90 percent. That leaves 11 cents to run your business,” she said.

One of AmeriHealth’s objectives as an insurance carrier is to secure the best value for its members. The cost of premiums often depends on the cost of services from physicians, hospitals, and ancillary healthcare providers.

Essentially, AmeriHealth New Jersey buys the healthcare provider’s services for its customers. Those providers often require higher reimbursement from the insurer because their costs are continuing to rise.

“When hospitals increase their rates, it drives the insurer to increase their premiums,” Roman said. “If that hospital bill keeps going up every year, then the premiums keep going up every year because we use that money that we collect in premiums to pay that bill.”

The crux of the reform debate lies in the issue of rising costs and burgeoning premiums. Oftentimes, Roman explained, the hospitals will complain that their hard costs are going up, facilities are aging and in dire need of renovation, technology and pharmaceutical advancements are required, etc.

“When we all evaluate the affordability act, these are the areas where we ask, ‘Well, how are we actually controlling the costs?’” Roman said. “And I think those are some of the unanswered and undefined areas because the cost to deliver the care continues to rise, but we want to make sure that we offer more services to more people.”

Growth on the horizon

To meet the demands of today’s healthcare industry, Roman outlined several areas in which AmeriHealth New Jersey is focusing its growth strategy. These areas include maintaining strong insurance-broker relationships; developing the right product mix; maximizing customer satisfaction; and delivering services that lead to strong customer-provider relationships.

As with most organizations, branding is essential to this strategy.

“In order for people to do business with us,” Roman said, “they need to know who we are. Five years ago, we were not very well-known in the state.”

However, AmeriHealth New Jersey’s statewide anonymity has started to fade.

“Someone recently said, ‘Boy, folks that work in your company are everywhere,’” Roman recalled. “We try to brand ourselves across the state. We participate in different opportunities that support the community.”

Roman described AmeriHealth New Jersey as being very community-minded.

“Our employees take the commitment very seriously,” she stated. “We are out almost every weekend doing something on a volunteer level.”

AmeriHealth New Jersey is especially involved in supporting the Special Olympics New Jersey.

“We volunteer at the summer games and the winter games,” Roman said. “We sponsor a run through the Lincoln Tunnel every year. We also sponsor a run across the Ben Franklin Bridge down in South Jersey and Philadelphia with the Larc School.”

AmeriHealth New Jersey also collects and delivers food donations to the Ronald McDonald House and participates in the United Way’s annual Day of Caring.

“The culture of our company is really centered around healthy mind, healthy body, helping community, educating on healthy behaviors, working with people to understand risky lifestyles, and lifestyle changes to improve overall health,” Roman explained. “We work hard to encourage the same behaviors with our employer groups.”

In the summer of 2011, AmeriHealth New Jersey became even more visible and centralized when both of its offices came together at one location in Cranbury, NJ.

Having always operated out of two different offices, Roman believes this move will increase efficiency and effectiveness in meeting the needs of customers and clients throughout the state.

Satisfying the customer

When an employer is shopping for health insurance, most of them base their selections on price, network, and service.

Roman said listening to the customer is essential when developing products and services for one simple reason. The customer typically has a well-defined budget.

“We need to design the products that are aligned with what the customer can afford,” she said. “And whether that be a narrower network or a broader network or more deductibles and co-insurance or co-pays, we need to be able to have that flexibility in developing the products that meet that customer’s expectations and ability to pay the premium.”

And AmeriHealth New Jersey does strive to listen to its customers in every possible way.

“We’re very open when it comes to having insurance-broker roundtables or bringing employers in to discuss what direction they’re headed and what they need from us,” Roman said.

In addition to listening to customers, Roman said it’s equally important to cultivate strong broker relationships “because approximately 95 percent of our business is sold through those insurance-broker relationships.”

Networking with doctors, hospitals, and other ancillary providers is also important for growth. Roman said that AmeriHealth New Jersey has worked for the last five years to develop a strong provider network throughout the state of New Jersey. As a result, AmeriHealth New Jersey now has the largest provider network in the state.

“We’re contracted with every hospital except for one acute-care hospital,” Roman said, “and we have now surpassed the other insurers in the size of our physician network.”

The final piece of the strategic puzzle is service. Roman offered one example as to how they service a customer whose scope of employment is not limited solely to New Jersey.

“Occasionally a New Jersey customer will have employees in another state,” Roman said. “When that happens, we contract with the largest PPO (preferred provider organization) network that covers the nation with almost 690,000 providers and 3,500 hospitals. When we do have someone that has employees outside of the area, we do have access to cover them seamlessly.”

More than just growth

Roman emphasized that AmeriHealth New Jersey’s goal is to help its customers and members maximize wellness in every conceivable way. AmeriHealth New Jersey offers a comprehensive wellness program that consists of on-site services, reimbursements, and discount opportunities to help members and their families lead healthier lives.

AmeriHealth New Jersey strategists are constantly asking themselves, “How do we keep people healthy? How do we prevent disease? Once we identify those with chronic diseases, what are the opportunities that we have to help them improve the quality of life and minimize the impacts of disease?”

Roman said it first starts with prevention and education.

“When you look across the country at the large corporations that have thousands of employees, many of them have these health and wellness programs, but the market of 51 to 500 really wasn’t receiving much focus,” Roman said.

AmeriHealth New Jersey was the first in the state to bring employer on-site wellness programs that are traditionally reserved for larger companies to small and mid-sized New Jersey-based organizations. These wellness activities include on-site screenings for such diverse needs as blood pressure, cholesterol, body mass index (BMI), and blood sugar to programs related to smoking cessation and weight management.

“Wellness has such huge economic implications,” Roman said. “We know there is a tremendous amount of money that employers can save at the same time because for every dollar on average that’s invested in these programs, they get three in return when it comes to saving money on services and claims.”

These educational programs often result in cost reduction on premiums, Roman added. Many employers use this as an incentive for employee participation in wellness programs.

Practicing what they preach

When it comes to education and wellness, AmeriHealth New Jersey strives to practice as a company what it preaches to its customers.

“We encourage our associates to complete personal-health profiles,” Roman said. “And we allow them to get their preventive screenings and physician visits on company time. If an associate goes for a mammography or a prostate screening or whatever is required from the American Medical Association for that individual’s age bracket, we will give them time off for preventive service.”

This is known as the Time Off for Preventive Screenings (TOPS) program.

“This incentive encourages healthy behaviors and also contributes to early detection, which is very important,” Roman said.

Investing in people

Roman said people, the human resources behind the business, are AmeriHealth New Jersey’s most valuable asset. After all, growth and wellness strategies can only be executed successfully if the right people fill the right positions.

Over the past five years, Roman said that AmeriHealth New Jersey has rejuvenated its senior management team. She wants the best individuals running the sales, marketing, and health-services areas of the company.

“What’s most important to us at AmeriHealth New Jersey is that we enhance the health and wellness of the people and communities that we serve and that we strive to be the best performing health-insurance plan in the state of New Jersey whether it be through access or quality or affordability.”

-by Pete Fernbaugh

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