MANAGED CARE January 1996. ©1996 Stezzi Communications
Managing Editor's Memo
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.