Managed Care Plans

Sick patients in managed-care health plans feel they're not getting the time, attention and treatment they think they need, according to a national survey released yesterday.The patients reported long waits for doctor's appointments, getting exams that weren't thorough, and dealing with physicians who spent little time with them and seemed not to care.But the same opinion survey found that the patients said they were paying less for their medical care and filling out less paperwork.Conducted by researchers at the Harvard School of Public Health, the survey of sick patients compared their opinions about their treatment under the two major types of health plans: fee-for-service and managed care.

While presidential candidates natter about health reforms that focus on insuring more Americans, a quiet but potentially very disruptive shift in defining the problem is under way in Washington. The long-standing conventional wisdom that rising health costs are inevitable as the population ages is being challenged by a view that patients in comparable conditions are simply consuming a lot more care than they once did - without an improvement in their health status. The older view accepts that consumption will rise and seeks to focus on who pays (accelerating the existing shift to insurers, especially the government, whose share of medical bills has actually grown in recent years)

More than 80 percent of employees in the Baltimore-Washington area, and nearly that many nationally, are covered by some form of managed care plan, according to an annual survey by Foster Higgins, the national benefits-consulting firm.The survey found only 23 percent of employees nationally covered by traditional indemnity health insurance -- compared with 52 percent just five years ago.Despite a steady growth in managed care, indemnity insurance will not disappear altogether, said John Welch, a principal in the Washington office of Foster Higgins.

WASHINGTON -- Two weeks after the Bush administration announced that Medicare prescription premiums would stay about the same next year, a new analysis by congressional Democrats indicates that for a majority of middle-class seniors, rates will jump 13 percent - well above the overall inflation rate. In a sternly worded letter to Health and Human Services Secretary Michael O. Leavitt, Rep. Henry A. Waxman, a California Democrat, accused the administration of "deceptive advertising." Medicare Administrator Mark B. McClellan fired back with a statement calling the analysis by Waxman's Government Reform Committee staff "inaccurate and misleading."

Sixteen years ago, Ruth Donati went to work as a receptionist for a group of five pediatricians in Towson. It took the equivalent of one and half people to do the paperwork for the practice, using an old punch card machine.Since then, the office has modernized; Dr. Felix Kaufman, one of the pediatricians, says the doctors have spent $100,000 on computer systems. And the practice has joined Premier Medical Group, which is taking over a chunk of the administrative chores.So it doesn't take one and a half people to handle the paperwork any more.

WASHINGTON - The association representing managed-care health plans warned yesterday that its members are likely to drop coverage of more than 700,000 people on Medicare. The reason, the group said, is that the government pays the plans too little per patient. "The numbers are staggering and tragic," said Karen Ignagni, president of American Association of Health Plans, at a news conference. "For hundreds of thousands of Medicare beneficiaries, today is the day Washington has failed them."

Responding to pressure from managed care plans and Maryland's congressional delegation, federal officials have agreed to reconsider a pilot project intended to save the government money on coverage of Medicare patients in Baltimore and six Maryland counties.The experiment, scheduled to start Jan. 1, is one of several efforts by the U.S. Health Care Financing Administration (HCFA) to get a better deal from managed care plans, mainly health maintenance organizations (HMOs), that enroll Medicare patients.

Maryland may have to delay implementation of its plan to switch Medicaid recipients into managed care plans to give more time to work out regulations, Sen. Larry Young, chairman of the state Senate Health Subcommittee, said yesterday.State health officials, however, said they are still ready to move ahead on schedule, beginning the process Jan. 1 and placing 220,000 Medicaid recipients in managed care plans by the end of June.About 110,000 additional Medicaid recipients are already in health maintenance organizations, but would have the opportunity to switch to other managed-care plans during the enrollment period for the others.

A crowd of nearly 700 health care providers, state lawmakers and experts jammed into a Baltimore hotel meeting room yesterday to work on the state's biggest health issue: how to cut costs and expand coverage by changing how nearly half a million Medicaid patients get their health care.The conference at the Omni Inner Harbor Hotel was a preview of all of the sticky issues state officials will face as they try to move Medicaid patients into managed care plans -- which coordinate care and restrict which doctors patients can see.Sponsored by the state Department of Health and Mental Hygiene, University of Maryland Baltimore County and the Milbank Memorial Fund, the conference kicked off a series of 10 public hearings state health officials will hold around Maryland beginning next week.

In a bid to cut costs and cater to its growing customer base, Aetna Health Plans of the Mid-Atlantic Inc. will open two medical offices in Maryland this fall and up to 15 more in the Baltimore-Washington region by year-end.The first two offices, to be staffed by two to four primary care physicians, will be opened in Montgomery and Prince George's counties and will serve 4,000 to 8,000 patients each, depending on the number of doctors.Aetna also plans to open similar medical offices in Atlanta this fall and around the country next year.

WASHINGTON - The association representing managed-care health plans warned yesterday that its members are likely to drop coverage of more than 700,000 people on Medicare. The reason, the group said, is that the government pays the plans too little per patient. "The numbers are staggering and tragic," said Karen Ignagni, president of American Association of Health Plans, at a news conference. "For hundreds of thousands of Medicare beneficiaries, today is the day Washington has failed them."

Just a year ago, Washington policy-makers looked to managed care as one of the best solutions to the rising costs of Medicare.Even as it reduced Medicare spending by $115 billion over the next five years, the Balanced Budget Act of 1997 envisioned that the number of beneficiaries enrolled in managed care would nearly double during the same period, to around 27 percent of all seniors.Today, there are signs that the government's goal of quickly increasing the number of health plans available to seniors was overly ambitious.

OXFORD HEALTH PLANS, a New England HMO with 1.7 million members, last week announced a number of steps it said were designed to offer "wider choices, better information and broader decision-making power to the consumer."In particular, it said some members would be offered direct access to care by specialists, without having to obtain approval from a "gatekeeper" physician. It also said it would aid consumer choice by giving members "performance profiles" on specialist teams, including success rates for particular procedures.

WHAT HAPPENS when your medical plan refuses to give you the care you believe you need? There's an appeals procedure. But it isn't much good if you're in mortal danger or serious pain, or you're being thrown out of the hospital just a few hours after major surgery. Welcome to the new world of medical rationing.It's going to get worse as health costs rise and employers fight to hold down their health-care expenses. But patients have ways of fighting back. In their anger and fear, they're creating a new political movement: a consumer crusade for patients' rights.

More than 80 percent of employees in the Baltimore-Washington area, and nearly that many nationally, are covered by some form of managed care plan, according to an annual survey by Foster Higgins, the national benefits-consulting firm.The survey found only 23 percent of employees nationally covered by traditional indemnity health insurance -- compared with 52 percent just five years ago.Despite a steady growth in managed care, indemnity insurance will not disappear altogether, said John Welch, a principal in the Washington office of Foster Higgins.

Mitchell Diamond likes to stay ahead of health care trends.From his consulting firm in the 1970s, he helped organize HMOs and the Maryland Association of Health Maintenance Organizations. His HMOs, he says, were among the first to use global capitation -- paying doctors a flat fee per patient to be responsible for all care.In the 1980s, as some started to complain that HMOs, by using "gatekeeper" doctors, limited their access to specialists, he helped develop preferred provider organizations.

U.S. employers' health benefit costs fell last year for the first time in more than 20 years, according to a national survey, while costs in the Baltimore-Washington area rose by a moderate 3.6 percent.The survey from the New York benefit consulting firm of Foster Higgins said the average total health benefit cost last year was $3,741 per employee, down 1.1 percent from 1993. In Baltimore and Washington, average costs rose to $3,849. Maryland employers reported a 1.5 percent drop, to $3,779 per worker.

In a small yet significant experiment, the federal government will test a new way of determining how much to pay for the health care of Medicare patients covered by managed care plans in the Baltimore area.The rate-setting test could have sweeping implications for health maintenance organizations as well as elderly and disabled patients on Medicare, touching everying from benefits to potential premiums.The experiment is the first in the country.The idea -- to apply market forces to get more for the government's dollar -- replaces an old formula for creating rates that critics say fails to take advantage of competition.

In a bid to protect roughly a fifth of its patient base, Johns Hopkins will form an HMO-like plan to enroll the poor and disabled as the state shifts its Medicaid patients to managed care.The Hopkins decision comes as a result of Maryland's decision to move all Medicaid patients into managed-care plans next year and reflects concerns of teaching hospitals, which have higher rates to cover education costs, that managed-care insurers will funnel patients to lower-cost hospitals.It also moves Maryland hospitals closer to thier goal of contracting directly with payers, thus capturing the piece of the premium dollar that has been going to insurance administration and profits.

One began in the last century with the desire to have a hospital in Baltimore that would treat black patients and would train and hire black medical staff. The other began in the last century with a small order of French nuns invited to Baltimore by the archbishop to treat people in their homes.Despite their disparate histories, Liberty Medical Center and Bon Secours Hospital have been brought together by some thoroughly modern, and some 21st century, considerations.The two urban hospitals are seeking to secure their place in a changing medical marketplace, combining to make themselves into the kind of full-service, cost-efficient institutions that appeal to managed care insurers.