The managed-care industry is fighting an uphill battle to regain public trust.
In recent weeks, politicians have been tripping over each other to introduce bills designed to curb the excesses of managed-care plans. All healthcare executives should be concerned that both houses of Congress and many state legislatures are threatening to impose broad and onerous regulations on health plans.
The American Association of Health Plans seems to realize the managed-care movement must clean up its act to avoid heavy-handed government rules. The trade group has gotten off to a good start, threatening to expel members for not complying with its "Patients First" initiative. But it's even more important for individual health plans to get their own houses in order.
No longer can HMO managers simply slash costs at will. Today's managed-care enrollees want assurances that caregivers will act in their best interests and do so with the support of the health plan.
Instead of forcing doctors to obey HMO rules, plans should bring physicians into the process to make sure utilization review is based on sound guidelines. A recent Commonwealth Fund survey found that 38% of physicians who work with managed-care companies say they have less control over patient decisions. Physicians will support care protocols they have had a role in crafting.
Physicians, politicians, providers and populists frequently attack the character and ethics of managed-care executives. To better counter the critics, health plans should respond by finding ways to add value to the healthcare delivery system. To do that, they must remember value is the relationship between cost and quality.
The AAHP is blazing the trail by promoting best practices, innovative programs and case studies that document ways health plans have improved the quality of care. But if Patients First is to become more than a catchy slogan, it's time for the group's members to prove their commitment.
Don't just tell us. Show us.