MANAGED CARE REFORM: HMOs Announce Pre-emptive Reform Package
California's "much-maligned" HMOs yesterday announced an agenda of self-reforms, as they are faced with the prospect of more than 70 bills that would "increase health plan liability and force an expansion of basic coverage." California Association of Health Plans President Walter Zelman unveiled a slate of reforms, including an independent review process to settle disputes about denials of care, a new state department to regulate managed care; expanded eligibility for the state's Healthy Families CHIP, and a "statutory guarantee that only physicians, not HMO executives, can deny care," Sacramento Bee reports (Young, 4/30). The plan would also guarantee access to medically necessary second opinions and improve disclosure of the incentives used to pay physicians. In addition, the plan calls for increased funding of the Major Risk Medical Insurance Board to subsidize the purchase of insurance for high-risk individuals (CAHP release, 4/29).
We Mean It
HMOs say "their planned reforms show they are serious." Blue Shield of California President Bruce Bodaken said, "California health plans are determined to regain the trust of their members. By defining a broad, significant reform agenda, we are taking a major step toward regaining that trust." But some consumer advocates complained that the CAHP proposal was long on rhetoric and short on details. Consumers Union's Betsy Imholz said, "The broad statements sound good, but when you get down to the specifics, my concern is that we won't be on the same page." And state lawmakers "said they were skeptical and that the industry failed to address one significant proposal: giving patients the right to sue HMOs" (Young, 4/30).