It was interesting and enlightening to read the views of the new HMO leaders (March 13, p. 28). It was even more enlightening to note that there was barely a mention of their relationships with healthcare providers-where patient care begins and ends.
In the early years of managed care, the goal was to improve care in a way that would lower overall costs. We believed-and many of us still do-that physicians should drive the care, and that effective managed patient care leads to a healthier patient base and thus, over time, to improved profits. Your story paints a very different picture about the direction of managed care today.
Managed-care leaders have traditionally come from healthcare backgrounds and had the understanding to maintain a balance between the medical and business sides of managed-care organizations. Today, too many HMOs are hiring business leaders to satisfy the demands of Wall Street.
Medicine is not a commodity. It cannot be packaged like widgets or managed like a department store. The former MedPartners, now Caremark Rx, found that out when it traded a focus on care for a focus on profits. Its failure caused hundreds of thousands of patients to lose access to their familiar clinics and doctors and cost hundreds of physicians and healthcare professionals their jobs. Is that the path we want to follow?
Managed care still has the potential to do what it started out to do: improve the health of Americans and control costs. But when shareholder value trumps quality care, patients lose and doctors lose; eventually the managed-care system will fail.
America can't afford to go back to the price and excesses of unmanaged care. HMOs and their providers serve the same members. We should be working together-first to meet the needs of patients, then to ensure a fair profit for both the providers and the managed-care companies.
California Association of Physician