Believing physicians can run a better managed-care plan, California physicians and a Midwestern insurer are considering establishing a statewide managed-care organization.
The California Medical Association and the California Foundation for Medical Care, which runs a statewide PPO, are teaming up with Wausau (Wis.) Insurance Cos. to form California Health Care.
"Patients, employers and physicians are becoming increasingly disenchanted with health plans that make it cumbersome for patients to get the care they deserve," said Ronald P. Bangasser, M.D., president of California Health Care. "There is a good market opportunity for a health plan that respects the physician-patient relationship and places quality patient care before profits."
Jeff Zriny, Wausau Insurance Co.'s vice president of 24-hour managed care, said, "Our goal is to give customers in California options for quality healthcare at reasonable prices."
California Health Care, which would contract directly with employers, would offer HMOs, PPOs and other capitated products, a CMA spokesman said.
All CMA and California Foundation member physicians meeting qualification guidelines would be allowed to participate in California Health Care. Physicians will control utilization review, medical management processes and all governing bodies, and "will receive due process before any adverse actions are taken against them," the CMA said.
Physicians will also receive actuarial and other information required to assess the performance of California Health Care.
California Health Care will try to maximize the percentage of premium spent on the delivery of healthcare and minimize administrative and overhead costs, the CMA said.