MANAGED CARE: New Laws, Plan Options Broaden Consumer Choice
The California Legislature has recently passed a number of laws that make managed care more flexible, the Los Angeles Times reports. In the past year, patients have "gained the right to get a second option from a medical specialist when their primary care doctor refuses to make a referral," and Californians receiving prolonged care -- such as women in the second or third trimester of pregnancy or cancer patients -- are guaranteed continuity of care with the same physician even when an employer changes health plans during the course of treatment. In addition, California's new Department of Managed Care has "ordered health plans that are dropping medical groups to notify their enrollees of the right to stay with their doctors." Employers are also providing consumers with choice -- 18% of U.S. employers offer more than one managed care plan to their employees -- giving workers important decision-making discretion during "open enrollment," the annual period during which changes in their medical insurance are completed. Peter Lee, president and CEO of Pacific Business Group in Health, said, "For many consumers, the time of 'open enrollment' doesn't get the attention that it warrants. ... The choices workers make [during open enrollment] may have a profound impact on the range of doctors or hospitals they can actually get to use later."
Consumers Should Do Their Homework
With the "open enrollment" period approaching, the Los Angeles Times reminds consumers that they have a number of resources to help make an informed decision, including the following:
- The National Committee for Quality Assurance (NCQA) rates health plans on more than 60 separate performance measures, and serves as the "gold standard" on accreditation. NCQA rankings can be accessed at http://www.ncqa.org
- The Pacific Business Group on Health provides annual "report cards" on California health plans. These ratings can be viewed at http://www.healthscope.org. Walter Zelman, president of the California Association of Health Plans, said California now offers "a good deal more choices and options than in the recent past. ... There are lots of positive opportunities for consumers who put some time and effort into the selection process. But there may be big ... disappointments for those who don't" (Rosenblatt, Los Angeles Times, 9/25).