Managed Healthcare Executive - December 2008 - (Page 15)

<< Ramón M. Ruiz-Comas Ruiz-Comas joined Triple-S in 1990 as vice president of nance. He became president and CEO in 2002. He is a member of the Puerto Rico Society of Certi ed Public Accountants and the American Institute of Certi ed Public Accountants. He holds an accounting degree and a JD. it was managed by a competitor. RuizComas says government o cials called him up and suggested that he submit a proposal to manage the region again. He believes the price Triple-S o ered as well as its scalable infrastructure helped win back the contract. “Our member retention rate is normally over 95%,” he says. “When we see the retention rate by carrier, Blue Cross Blue Shield is the highest in the United States, and we are above that average of about 89%.” Triple-S also o ers the Blue Card, which allows members visiting the United States coverage and access to the Blue network. The reverse is also true in that the growing number of U.S. companies that have operations and employees in Puerto Rico can access the Triple-S network. He says it’s a big selling point because the commercial clients gain the advantage of the Blue-negotiated rates. Cost control essential According to Douglas B. Sherlock, CFA, president of Sherlock Company, a nancial and operations advisory rm based in Pennsylvania, managed care organizations that hope to be successful and compete in today’s environment must rst meet the classic obligations of governing with a board of directors that is competent, that puts the plan rst and has a sense of loyalty to the plan’s duty to deliver care. “What’s really interesting about the managed care world is that the skill sets for successful health plans change over time,” he says. “The skill sets that were successful in the 1980s or 1990s are not necessarily the skill sets that are best now. This happens to be a period of time in which cost control is the preeminent skill set.” Triple-S could nd controlling costs challenging in the U.S. market, especially as the nation struggles with economic emergencies while at the same time is envisioning ways to decrease the ranks of the uninsured. Román says Triple-S’s e orts to control costs with its current members encompass a variety of strategies. In recent years, the plan has done a better job of shifting drug utilization toward generics, for example. Commercial groups are now split 50%/50% between brand and generic, whereas, two years ago, the split was 60%/40%, which is signi cantly less than the generic utilization trends in the United States. He also says maintaining a versatile operational structure has kept costs in check, and he expects the foundation to support future managed care acquisitions in Puerto Rico in the next year and the potential expansion into the U.S. market. “We have a big infrastructure that is very scaleable,” Román says. “We grew signi cantly in Reform and in Medicare Advantage, and the investment in our infrastructure, which is the xed cost, has not been that signi cant.” DECEMBER 2008 15

Table of Contents Feed for the Digital Edition of Managed Healthcare Executive - December 2008

Managed Healthcare Executive - December 2008 For Your Benefit Editorial Advisors Contents News Analysis Politics & Policy Letter of the Law Puerto Rico’s PLAN State Report Bundled Payment Technology Drug Class Overview Managed Care Outlook Desktop Resource Ad/Edit Index

Managed Healthcare Executive - December 2008

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