Hardly a day goes by without some provider group trumpeting new efforts to reconfigure into a community-based, slimmed-down, cost-efficient, network-linked, high-quality, managed-care enterprise. But while every hospital and physician group is discussing linkages in a bid for survival, a disturbing mind-set is developing. In some areas, near-panic exists as Columbia/HCA Healthcare Corp. digests Healthtrust and seeks to develop statewide managed-care networks.
Such paranoia fuels many ill-conceived efforts to link with a group of primary-care physicians and offer a managed-care plan designed to assure success by grabbing a bigger market share for existing physicians and medical institutions.
Unfortunately, hospital organizations don't have a strong track record in running health plans. Exceptions include SelectCare, in Troy, Mich., and UniHealth America's CareAmerica Health Plans. Such plans operate under managed-care professionals who understand the difference between running a hospital and running an HMO.
Hospitals that hope to be successful managed-care partners must be comfortable with aggressive efforts to cut inpatient admissions to the lowest in the market. But unless executives are dedicated to addressing the community's public health needs, managed care simply pushes down the supply side of the healthcare equation without working on the demand side. Such efforts can only result in ethically questionable quality reductions.
Prevention can pay off. A recent HCFA report found that elderly Americans who belong to Medicare HMOs are more likely to have certain cancers diagnosed early. The reason: Coverage of mammograms, Pap smears and other routine screenings is not available in Medicare fee-for-service.
Providers that more effectively manage patient care instead of perpetuating costly excess capacity will convince policymakers and the public that the industry can reform itself.