If managed care is to become more accountable, health plans must enhance quality, improve customer service, stop the financial bleeding and fight back against those who distort the facts.
Hospitals and health systems are tackling image problems, but those challenges pale in comparison to those faced by the beleaguered managed-care industry.
HMOs in particular have been skewered by a relentless pack of opponents ranging from consumer advocates and physician groups to trial lawyers and politicians. For most of the year, it appeared Congress would pass an onerous patient-protection bill that would leave HMOs vulnerable to lawsuits from patients upset about coverage decisions.
But then Bill Clinton, Monica Lewinsky, Mark McGwire and Sammy Sosa teamed to bump managed care off the front page. The slight media thaw also helped HMOs regroup to blunt some of the criticism.
Now it's up to the managed-care industry to cut out the delays, questionable denials, inflexibility and other monkey business. Physician gag orders, references to "medical loss ratios" and cumbersome barriers between patients and specialists also need to go.
We suggest that hospital, health system and other provider managers monitor local reaction to a spate of new public relations campaigns designed to polish the tarnished image of HMOs. Aetna U.S. Healthcare recently launched a $7 million advertising initiative featuring testimonials from its enrollees. Kaiser is spending $10 million to advertise that doctors, rather than insurance administrators, make the medical decisions.
On the media side, watch how the public responds to attempts to balance tear-jerking HMO horror stories so effectively spread by the Clinton administration, disgruntled physicians and other critics. The Wall Street Journal and Washington Post have already questioned some of the patient mistreatment stories. Similar stories will follow.
Improving quality is the surest way for managed care to upgrade its image. At this point, there are mixed messages on how the coordinated approach to care affects medical outcomes. The National Committee for Quality Assurance said managed care's quality is about the same as last year, while patient-satisfaction levels have dipped slightly. More alarming is that nearly half the 329 plans that participated in the NCQA evaluation program last year did not report this year. However, 121 new plans participated this year, resulting in a net drop of 37 plans.
The financial picture actually is brightening. Standard & Poor's reports that HMOs have improved their cost-management strategies. Because they are less focused on growth, HMOs are paying doctors faster and increasing copayments. Many are also entering more favorable contracts with employers.
Such momentum must continue if managed care is to achieve its promise and ensure its future.