Medical directors from four of the largest investor-owned HMOs last week fielded reporters' questions in the first of several forums designed to improve managed care's battered public image.
It marked the first time HMO executives have called a joint press conference in an attempt to counteract recent negative media coverage. Reporters were invited to the San Francisco press conference by the Coordinated Care Coalition, a group formed by FHP Health Care, Fountain Valley, Calif.; Health Systems International, Woodland Hills, Calif.; Humana, Louisville, Ky.; PacifiCare Health Systems, Cypress, Calif.; United HealthCare Corp., Minneapolis; and U.S. Healthcare, Blue Bell, Pa.
The group, which has tackled legislative issues, decided recently to open a dialogue with reporters.
The coalition has retained Powell Tate, a public relations company based in Washington, to help put the media forums together. Organizers have not decided how many such forums they will hold or what the schedule will be.
Participating in the San Francisco press conference were John Davren, M.D., president of FHP Ohio; Lee Newcomer, M.D., chief medical officer, United; Stanley Padilla, M.D., vice president for medical affairs for Health Net, HSI's California subsidiary; and Roger Taylor, M.D., executive vice president and chief medical officer of PacifiCare.
Taylor said he was "frustrated" at the portrayal of HMOs in the media. He and other physicians entered managed care to be "in the forefront of restructuring a system....that had no accountability in it," he said.
HMOs have assembled broad networks with quality levels "unprecedented in fee-for-service," he said.
Newcomer said his company has improved quality while reducing costs in several areas.
The executives defended for-profit HMOs as market-driven to provide increasingly better care at lower cost. Taylor cited Medicare risk plans as giving seniors more benefits than fee-for-service Medicare at less or no cost to them.
Meanwhile, Newcomer said physicians have no incentive to deny care to save money because they can approach medical directors if capitated fees are too low. Their fees are then adjusted, he said.
The executives said more physician groups are asking to be capitated and that at-risk doctors are able to provide more "creative" care than under fee-for-service plans.
Taylor said it's the specialists who are complaining about managed care because they are in oversupply and are facing lower incomes and loss of their practices. Newcomer said some doctors are uncomfortable with capitation because "all of a sudden, they are accountable for what they do."
All four executives stressed that their plans' contracts contain no gag clauses that prevent open communication with patients about all treatment options.
"Managed care is not the message but the messenger," Taylor said. The message is that the system was broken, and HMOs became part of the dynamics that evolved to fix it, he said.