Another managed-care company is breaking the mold with a new way for enrollees to access its delivery system.
Last week, Oxford Health Plans said it will allow enrollees to bypass primary-care doctors and go directly to medical specialists for a wide range of conditions.
Norwalk, Conn.-based Oxford said it is reorganizing by negotiating contracts directly with specialist teams that will be responsible for comprehensive disease management. The specialist rather than the traditional primary-care gatekeeper will control the patient, Oxford said.
Already more than 200 specialist teams have been formed, Oxford said, with 500 more expected to be in place by year-end.
So far Oxford has developed 25 disease profiles for which it has requested provider team proposals. The teams are compensated through negotiated case rates that are paid in pieces as patients reach predetermined treatment milestones. As a result, analysts said Oxford will reduce outlays for high-cost cases.
By the end of 1998, Oxford expects to have 150 disease profiles in place that will cover 95% of specialist spending, said Stephen F. Wiggins, Oxford's chairman and chief executive, at a news conference in New York. In announcing the changes, he fired a shot across the bows of "hospital-centric" delivery networks and their affiliated physician-hospital organizations that seek to keep "patients in the stovepipe."
As part of the plan, enrollees will be provided with simple report cards that allow them to shop for specialists based on outcomes and affiliations, Wiggins said.
"The market is demanding what they're creating," said Eleanor Kerns, an industry analyst with Alex. Brown & Sons in Boston. "And the appetite . . . is very large. People are by and large willing to pay a premium for that choice."
Oxford has grown explosively. As of this month, its enrollment stands at 1.7 million, up from 1 million in 1995 and 513,000 in 1994. Despite its torrid growth and recent computer snafus, Oxford has earned consistently high customer satisfaction ratings and boasts renewal rates of 99% among employers and 98% among participating physicians.