MANAGED CARE: Ombudsman Projects Proposed
"Sacramento lawmakers, who have criticized the state's HMO watchdog agency for not being quick to respond to complaints, are considering a proposal to set up two regional ombudsmen projects," the Contra Costa Times reports. Another measure being proposed would require the state Department of Corporations, which is charged with overseeing HMOs, "to hire nonprofit advocacy organizations to help consumers." State Sen. Herschel Rosenthal (D-Van Nuys), who authored the bill to create "regional ombudsman programs," noted that the "bill is about consumers going to independent health care experts for advice and assistance, not to the health plan that has caused the problem or to government bureaucrats." The Contra Costa Times notes that if the measure is approved, the program "would likely be modeled after the Health Rights Hotline, a privately funded program that has been serving residents in four Sacramento-area counties since July." The program's toll-free number provides "information, referrals, or help with health plan problems."
What It Costs
Mark Sektam, vice president of legislative affairs for the California Association of Health Plans said the industry was concerned that the "new legislation may impose additional costs," and may duplicate existing internal programs at HMOs. He said, "We don't have a conceptual problem with the establishment of pilot projects, but we have some concern about funding, how much would come from health plans." According to Shelley Rouilard, program manager for the Health Rights Hotline, the hotline "costs about 70 cents per person per year." A study by the hotline of Medicaid advocacy programs found they cost about $1.54 per member annually. According to Dr. William Walker, director of the Contra Costa County Health Care Services Agency, the Contra Costa Health Plan's ombudsman program costs $60,000 annually. Walker said, "If there's anything the public is asking for right now in the emerging controversy around managed care is a way to keep health plans honest. If we can afford an ombudsman, others can as well (Appleby, 4/13).