Managed Care

 

A Patient's Perspective: Is There No Better Way?

MANAGED CARE January 1996. © MediMedia USA
Managing Editor's Memo

A Patient's Perspective: Is There No Better Way?

Timothy Kelley

Twenty years ago, as a weekly-newspaper reporter in the town of Enumclaw, Wash., I spent a day covering flooding that had afflicted several nearby towns. Then I came home to my basement apartment and discovered that the "news" had touched me more intimately than I'd known. I was flooded out.

I thought of that day after what happened recently when our company chose a new health plan. Knowing a thing or two about the process because of our line of work, our group publisher made sure that if he selected any plan with a closed panel, that panel would include all of the primary care doctors with whom we staffers had existing relationships. He found a well-regarded HMO that met that test. So far, so good.

It took less than a month for verbal fisticuffs to break out in my mailbox between my doctor and my new HMO. "We very much regret Dr. X's decision to enter into a restrictive agreement with a competitor which, in part, requires him to reject all Plan Y members," huffed a letter from the HMO, while the physician's memo insisted that "no action that we have taken would have any impact on our ability to provide care to you . . . The decision to terminate the relationship was made by Plan Y. I fought this decision for the good of my patients to no avail."

I don't know who's right. But when my doctor adds that he has "good relations with other insurers," it's like telling a flood victim that it's dry in the Arizona desert. Our small company can afford only one health insurance option, and the exhaustive paper work has been done. Despite some concerns left over from a surgical procedure last year that make me especially prize continuity of care, and despite the best efforts of my employer, it looks like I'm now doomed to go doctor-shopping.

As an editor I understand that this is part of a market transition that also promises new ways to improve the quality of care.

But as a patient I resent it.

As the saying goes, there's got to be a better way.

Meetings

Private Health Insurance Exchanges Conference Washington, D.C. October 7–8, 2014
National Healthcare Facility Management Summit Palm Beach, FL October 16–17, 2014
National Healthcare CFO Summit Las Vegas, NV October 19–21, 2014
National Healthcare CXO Summit Las Vegas, NV October 19–21, 2014
Innovative Member Engagement Operations For Health Plans Las Vegas, NV October 20–21, 2014
4th Partnering With ACOs Summit Los Angeles, CA October 27–28, 2014
2014 Annual HEDIS® and Star Ratings Symposium Nashville, TN November 3–4, 2014
PCMH & Shared Savings ACO Leadership Summit Nashville, TN November 3–4, 2014
World Orphan Drug Congress Europe 2014 Brussels, Belgium November 12–14, 2014
Medicare Risk Adjustment, Revenue Management, & Star Ratings Fort Lauderdale, FL November 12–14, 2014
Healthcare Chief Medical Officer Forum Alexandria, VA November 13–14, 2014
Home Care Leadership Summit Atlanta, GA November 17–18, 2014