HMO MEDIATORS: Nation Looks To California Experiment
"A pilot project that allows Sacramento-area consumers at odds with their HMOs to seek help from an ombudsman advisor is attracting national attention as a possible remedy to widespread public concerns about managed care plans," the Los Angeles Times reports. The program "is the first to systemically track patients' problems with their health plans and to determine what role an ombudsman can play in aiding consumers." It "is being closely watched by health policy experts as Congress and many states consider legislation to tighten oversight of the fast-growing managed care industry." Both President Clinton and Gov. Pete Wilson's managed care reform commissions gave the ombudsman concept "big boosts." Kaiser Family Foundation Program Director Larry Levitt said, "There's a lot of buzz now that the ombudsman concept is probably one of the most important consumer protections."
While the health insurance industry "vehemently opposes" managed care reform regulations that would allow consumers to sue HMOs, many health care experts "see the ombudsman idea as a less controversial reform that could be acceptable to all sides." Levitt said there are "rumors that an external appeal mechanism is an obvious compromise for the managed care industry." The Los Angeles Times reports that a few "influential HMOs" -- including Kaiser Permanente and Group Health Cooperative of Puget Sound -- have endorsed the idea of an "independent, nonprofit" ombudsman. Peter Lee, an attorney for the Center for Health Care Rights, a patient advocacy group which helped organized the Sacramento pilot project, said "about 1,000 consumers have contacted the ombudsman program, which includes a toll-free hotline and counselors who help the public with managed care questions." Lee said, "There is a very significant pool of people in managed care who are having difficulties making the system work for them. The outstanding question is how well managed care is doing in resolving these problems" (Olmos, 3/19).