New-Generation Health Plans: Lean Customer-Driven Machines?

In Corporate America, customer service has moved to the top of the business plan. That's not to say customer service training has improved — how many times have you dealt with some surly 19-year-old when trying to return something to a store? — but the idea has gotten traction in theory, if not in execution.

The managed care industry, now somewhere in the age range of those 19-year-olds, could easily have demonstrated the same level of arrogance. Employers pay the bills and demand low premiums — who cares what the people want? Yes, it can be argued that health plans could have remained rigid until political pressure forced them to examine their relationships with members. But savvy plans have come to recognize patients, not just employers, as customers, ever willing to walk away when service is lousy.

The result is illustrated in this month's cover story. The industry is changing, in terms of business models and product offerings. Call it consumerism, member self-management, or whatever, but the direction clearly is to give members more say in their care. Now, it's one thing to recognize that “The customer is always right.” It's quite another to deliver a product that satisfies customers without letting them run your company into the ground. Health plans are getting warmer with members, developing administrative and care-delivery vehicles to make that change easier, but behind their smiles is a firm resolve to make members more responsible for the consequences and costs of their actions.

Where does this leave physicians? As patient advocates, physicians might be expected to welcome this development. In helping patients make better health care choices, physicians have a chance to raise their stature and clout in the eyes of health plans.

Our Q&A interview, too, hits on this theme of consumer independence. Tom Miller, director of health policy studies at the Cato Institute, makes a strong argument for disconnecting insurance from employment. Whether you agree or disagree with his reasoning — and our role is not to promote an agenda but merely to be a forum for ideas — it's provocative reading.