Community reproductive health clinics have long been the providers of choice-and often of last resort-for millions of men and women.
These clinics, and the government agencies that coordinate them, have decided that partnering with managed-care companies would benefit all concerned. So they're trying to contract with HMOs.
So far, HMOs have not shown much interest, with the exception of some of the many HMOs attempting to serve the Medicaid population.
Among the clinics are affiliates of Planned Parenthood Federation of America, which has been serving the reproductive health needs of women for 75 years.
Planned Parenthood officials spoke at the recent Group Health Association of America conference in San Diego on the mutual benefits of partnering with HMOs. They said their presentation piqued the interest of several HMOs.
Currently, "most HMO contracts with Planned Parenthood affiliates start with abortion services," Linda T. Williams, executive director of Planned Parenthood of Mar Monte, Calif., told MODERN HEALTHCARE.
But Planned Parenthood believes it can offer them much more. For instance, its clinics prevent thousands of pregnancies a year. "That's a lot of avoided inpatient
days," Williams said.
Two California family-planning agencies, which pass state and federal funds along to affiliated clinics, agree that the clinics could benefit HMOs.
"We have developed a steady relationship with our clients. Our women are better (contraception users) because of the level of information we provide," said Margie Fites Seigle, executive director of the Los Angeles Regional Family Planning Council, or LARF, and the California Family Planning Council. Her agencies also monitor the services reproductive health clinics provide.
Planned Parenthood's 164 national affiliates, with almost 1,000 clinics conveniently located in shopping centers or on major bus routes, have a loyal base of satisfied clients. In a 1993 nationwide telephone survey of randomly selected women ages 16 to 49, 24% of 1,200 respondents said they were current or former Planned Parenthood patients, Williams said.
According to the latest available figures, in 1993 Planned Parenthood provided services-such as contraception, gynecological exams, vasectomies and abortions-to more than 2.4 million men and women.
Most of the patients use the clinics as their only source of healthcare, Planned Parenthood executives said. In fact, some clinics "are moving significantly into primary care," Williams said. "Our medical director is an internist, and there is a pediatrician on staff."
The clinics also are affordable and accessible. Patients are charged on a sliding-scale basis according to their ability to pay. For example, a basic pelvic exam and Pap smear for a low-income woman costs $55, and some patients without insurance qualify for free exams, according to the Mar Monte clinic. Appointments aren't necessary, and hours are extended to early mornings, evenings and weekends. Some services available to teens are free, and confidentiality is assured.
For those reasons and others, it would make sense for HMOs to partner with Planned Parenthood, said Charles L. Moore, a Boston-based consultant working with Planned Parenthood. HMOs are concerned with controlling costs, enhancing quality, improving enrollee satisfaction and increasing enrollment; and Planned Parenthood can help in all these areas, Moore said.
At the same time, with the nation's Medicaid population moving into HMOs, Planned Parenthood and other reproductive health clinics need to affiliate with HMOs in order to keep their access to this group.
The Mar Monte affiliate has a contract with Aetna Health Plans of Northern California only for abortion services. "We don't contract with (Planned Parenthood) for professional services because all that's done through our (independent practice associations) and medical groups," said Elizabeth Koval, Aetna contract specialist in San Bruno.
Aetna contracts with Planned Parenthood, as with other ancillary providers, "to complete our network and make sure services are available to our enrollees," Koval said.
Williams conceded that for clinics that want to serve HMOs, at the moment "it's more realistic to be a subcontractor." The Mar Monte affiliate has a contract for full reproductive services with a medical group that serves HMOs, and several HMOs and managed-care plans have letters of intent to contract with Planned Parenthood Mar Monte if the plans win the state's Medicaid contract for Santa Clara County, Williams said.
Doreen Gounaris, director of operations at Smart Care, a small-business HMO in Long Beach, Calif., heard the Planned Parenthood presentation at the GHAA conference. As a result she is considering developing a product that would allow Smart Care members to use the clinics. Gounaris said Smart Care also is interested in accessing the Medi-Cal population through a partnership with Planned Parenthood.
The two California agencies, LARF and the California Family Planning Council, administer state and federal funds for reproductive services and monitor and coordinate services at 75 clinics statewide. Most LARF and CFPC clinics are not affiliated with Planned Parenthood and do not provide abortion services.
The California agencies would like to serve as intermediaries to develop a partnership between affiliated clinics and managed-care plans, Seigle said. LARF has made a start in this direction.
Under federal law, Medicaid recipients are allowed to go outside their managed-care plans for family-planning services. LARF now has a pilot project in Los Angeles County in which it bills HMOs for services provided to their enrollees at LARF's 28 clinics. The project involves obtaining medical records and the specific information that plans need from providers and screening women to see what plans they belong to.
The next step would be to contract with HMOs for a range of reproductive services, Seigle said.
Though LARF clinics serve mostly low-income women, Seigle believes the competent, accessible services would be attractive to middle-class women in HMOs as well.
However, Seigle said one problem with HMO partnerships is "a basic philosophical difference: confidentiality. We believe very strongly that when a woman comes to us for services, she needs no one's permission." But permission would be necessary if the managed-care plan had a gatekeeper.
In addition, how could a clinic bill an HMO for services to a member who requests confidentiality?
"The ideal would be if we could contract with the HMO for them to accept basically blind data from us," Seigle said. And for the HMO "to accept the fact that family-planning services are so cost-effective from the beginning that even if a duplicate Pap smear were done, it would be cost-effective" to the HMO in the long run.