The article "HMOs groups plan counterpunch to media criticism" (Dec. 11, 1995, p. 60) made several excellent points. However, the managed-care industry's strategy as outlined, and that was recommended by Kathy Lewton of Porter/Novelli, lacks one significant component: the involvement of employers.
Major employers have facilitated the growth of managed care in this country by moving their employees into health plans in order to reduce costs and improve care. Several have pioneered programs that evaluate the quality of care, including the National Committee for Quality Assurance's HEDIS measures. Their efforts improve quality and increase accountability for all patients.
Employers have a major stake in the future of managed care. A partnership between the managed-care industry and employers to explain managed care's value and successes is necessary and offers the best opportunity to improve the image and understanding of managed care.
However, not all managed-care organizations are the same, and the public has the right to know that. Employers are supporting a new effort, the Foundation for Accountability. Its goal is to establish common outcomes measures and improve accountability among health plans. Employers have pushed for more outcomes and satisfaction data to be made public so they can offer workers health plans with the greatest value without compromising quality.
The managed-care industry finds itself in the same position the health insurance and hospital industries did five years ago. The insurance industry was a major participant and target during the debate on national healthcare reform. Now that the market is making reforms itself, the managed-care industry is front and center. It's easier to target this industry because there are only about 600 HMOs seen by the public as the overseers of their healthcare. Patients were denied access to certain treatments under the old system just as they are now. However, managed-care plans have to make those decisions on a more rational and justifiable basis in these times of cost containment and increasing accountability.
The industry is being blamed for many things that happen because of human error. Delivering healthcare is a complex process that involves many people to care for one patient. Sometimes bad things happen. However, health professionals and providers need to work together to develop better systems of care, which will reduce inefficiencies and errors.
STEPHEN L. DAVIDOW
Stephen L. Davidow & Associates