Managed Care Plans

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.

WASHINGTON -- In a move that will help consumers and employers compare the quality of health plans, an industry group yesterday released a report that places the Columbia Medical Plan among the top five for "quality of care" in the country.Using data available to the public for the first time, the report measures plans' performance in dozens of ways such as the percentage of immunized children, the rate of births by Caesarean section and the percentage of doctors who are accepting new patients.

As part of a strategy to dominate health care in the mid-Atlantic region, Johns Hopkins Medicine has affiliated with Suburban Hospital in Bethesda, creating a partnership that should make both more appealing to managed-care plans and patients in the Washington area.The agreement announced yesterday calls for Hopkins and Suburban to launch projects together in populous Montgomery County, including an outpatient center similar to Hopkins' Greenspring model in Baltimore County.In a twist, the two medical institutions also will collaborate with the National Institutes of Health's hospital, a first for the Bethesda research institution.

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.

Not long ago doctors and hospitals were the unchallenged center of the medical world. No more.Just since 1980, enrollment in health maintenance organizations (HM0s) has increased six-fold, and today more than 50 percent of all Americans get their medical care through a managed care system. Health care is no longer a series of individual transactions between patients and those who offer care. It is a corporate enterprise: Managed care companies control who provides and who receives services and under what circumstances.

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.

Faced with shifting tens of thousands of poor people into managed care in January, Maryland health officials have set a tight timetable for a daunting task: resolving the grittiest of details about how the new system will work.Regulations must be written by the end of the summer, to reach two legislative committees by Sept. 15, and get final scrutiny by the influential Administrative, Executive and Legislative Review Committee that evaluates all state regulations by Oct. 1.Dr. Martin P. Wasserman, state health secretary, revealed the schedule last week at a meeting of the advisory committee that has helped craft the plan to move most Medicaid recipients into health maintenance organizations.

Aetna Life & Casualty Co. announced yesterday that it would buy U.S. Healthcare in an $8.9 billion deal that would forge the largest managed-care company in the United States, reaching one in 12 Americans.The purchase demonstrates how managed care is overtaking traditional health insurance. It also accelerates a trend toward consolidation and the blending of roles between traditional insurers, managed-care companies and providers.In becoming the largest, Aetna vaults over United HealthCare, which itself jumped into the No. 1 spot with a huge takeover -- the $1.6 billion purchase last June of MetraHealth, an insurer that represented the merged health businesses of Travelers Group Inc. and Metropolitan Life Insurance Co.Another example of the consolidation trend was provided last week, when Columbia/HCA, a for-profit hospital chain, bought most of the operating units of Blue Cross and Blue Shield of Ohio for $300 million.

If you're feeling rushed in the doctor's office, join the crowd. Prodded by health care managers, physicians are trying to squeeze more patients into every hour, to the point where many worry that care is being seriously shortchanged."

Plans must include emergency careThe Sun's Jan. 31 article, "Doctors, HMOs call truce in Annapolis," reports on an understanding between managed care plans and the state medical society of Maryland.We commend this cooperation, but the agreement language requires emergency physicians to obtain permission from managed care gatekeepers to treat subscribers who present non-life-threatening conditions.Federal law mandates that emergency departments screen and stabilize all patients regardless of ability to pay, and prohibits any delay to inquire about insurance or obtain approval from third parties.