DEPT. OF MANAGED CARE: Responsible for ‘Vigorous Oversight’ of HMOs
California's new Department of Managed Care "must not repeat the failure" of California's previous managed care regulator to "monitor basic HMO economics," a Los Angeles Times editorial states. In response to UnitedHealth Group's "bait-and-switch" move of unloading 225,000 of its least profitable California customers on Blue Shield of California last week, the editorial urges Daniel Zingale, director of California's newly established department, to require UnitedHealth to "promise that the deal won't unduly disrupt patient care -- for instance, forcing women in late pregnancy to switch doctors." The editorial also states, "Zingale should use his authority to ensure that HMOs are not promising benefits that they know they can't cost-effectively deliver." The editorial adds that because the California courts have little experience in dealing with HMO sales-practice lawsuits, companies looking to avoid such lawsuits and consumers who "expect a right to stability" will anticipate "vigorous oversight" by the DMC. The editorial concludes, "Assessing the fiscal health and care providing ability of hugely complicated HMO companies is no easy feat, but it's the only way to protect patients and preserve the credibility of managed care" (7/20).This is part of the California Healthline Daily Edition, a summary of health policy coverage from major news organizations. Sign up for an email subscription.