Health plans are a major component of the health care delivery system, a fact that is often overlooked from a disaster readiness perspective. Much focus in previous decades was on how to prepare hospitals for a crisis—and many have worked hard over the years to ensure that they truly are ready to respond to disasters. With the events of 9/11 and Katrina, the entire health care delivery system was interrupted and insurers were faced with how to ensure that health care services were delivered to their members. Crisis management was one of the topics at several industry events I attended recently, and the conclusion is this: we might not be as ready as we could be.

Within the industry, thoughts on how to deal with disasters are evolving. Especially in the health plan sector, disaster readiness has traditionally concentrated on recovery of computer systems—how do we get our systems up and operational? This certainly may be the foundation of a disaster readiness plan. Most of us (hopefully) have this in place and test it at least annually. But this is only one of the three areas of planning that must be performed; it is crucial that the "people" and "process" aspects of recovery are designed as carefully as the technical piece.

Let's talk about process first. What needs to be done to sustain operations? Certainly, core functions must continue. For example, billing and claims payment impact the viability of health care delivery. Claim payment delays threaten access to care, and payors need to receive payments in order to maintain operations and pay their employees. During a crisis, normal business operations are replaced with a few core functions, among them, member/provider call center operations, network management, care management, claims payment, and billing. (Note that the processes in place for these functions may change. For example, prior-authorization processes might be eliminated, or advance payments might be made to providers. After Hurricane Katrina, members were able to go outside their provider networks for care.)

Another part of the process aspect involves definitions of alternative roles. What is the role of each organization, and what needs to be done differently during a crisis? Member services may normally be primarily an inbound call center. In a crisis, they might need to try to reach members to provide information regarding where to get necessary care and about expanded benefits. The call center—and, one hopes, a Web portal—might become a part of the communication hub for staff, agencies, and stakeholders. Roles may also need to be defined at an individual level. Take into account anticipated staff availability and the amount of disaster preparedness training that employees have had. Sue's normal role may be as a provider relations representative, but she may be reassigned to work solely on advancing claims payments to select providers.

In terms of people, do you have a backup plan if your normal staff is unavailable or your staff is unable to work at their normal location? If the problem is with your building or its location, are there other places to easily get a core team operational? It may mean taking over part of a hotel or college campus or having people work from home temporarily. Consider, too, what to do if sustaining local operations is too difficult. If you are a national health plan with numerous operations centers, your options will be different from those of a regional health plan with a single operations center. Regional plans may need to have an arrangement in place for an outsourcing company to provide interim services during a disaster, such as claims receipt and payment, call center services, and billing functions. If you take this path, detailed procedures will need to be defined to ensure that the outsourcer can be ready as soon as possible.

Although much of this article has focused on what needs to be thought about to prepare for a major disaster, alternative processes should also be defined for incidents that are smaller in scope or duration, such as a flu outbreak or a phone bank failure.

Surrounding all of the aspects discussed above is the maintenance of a detailed communication plan, the cornerstone to success. The ability to communicate with all internal and external stakeholders is essential. How will you communicate your plan and exchange information with your employees? With members? The provider community? Local, state, and federal governments?

Whether it is a health epidemic, major equipment failures, weather issues, or terrorism, health plans need to be ready. In all of these examples, a company must be able to "flip a switch" and implement a different workflow process quickly. In addition, the crisis processes that you defined will still need to be modified based on resource allocation, nature of the issue, and so forth. Chances are that the plan will support only 80 percent of what is needed, so be prepared to define and implement new workflows on the fly. And don't forget, when the crisis is over, the company will need to be transitioned back to normal operations in a systematic fashion.

A crisis management team can define potential risks to the health plan and stakeholders, determine the likely outcomes, and determine the processes and resources that need to be put in place. Once these processes and resources have been determined, technology can support alternative process mapping and flip-of-the-switch execution.

We recommend that health plans that have not assigned a task force for disaster readiness do so. Those who have done so need to review and refine their plans periodically. Please let us know if you need help.