MANAGED CARE REFORM: IHA Issues Recommendations
The Integrated Healthcare Association, a California health care leadership group, is recommending that the state create a new department to oversee HMO and non-HMO managed care. The recommendation is one of several made in the group's final report on managed care reform in California. IHA also advocates the creation of standards for utilization review and wellness programs, collaboration on electronic medical records and performance measurement, and a binding, independent review of denials of medically necessary care by health plans. The association issued a summary of its key principles and recommendations last October to Gov. Pete Wilson's California Managed Health Care Improvement Task Force.
The new HMO regulatory department backed by the IHA would combine the oversight functions of the state Department of Corporations, the Department of Insurance, the Department of Industrial Relations and the Department of Health Services. According to IHA, the new department's appointed director should have significant experience in health care. In addition, the department should have a clinical information system and actuarial staff and an advisory committee comprised of health plan, provider and consumer members. IHA suggests that the new department collaborate with health plans, providers, employers and consumers to establish: accountability procedures for providers sharing risk with health plans; binding third-party reviews of disputes between health plans and enrollees over denials of care; basic standards for utilization review and health and wellness programs and a coordinated strategy for electronic data exchange and public reporting of health plans' performance measures. IHA Board Chair Shelley Horowitz, administrator of Hayward-based Bay Valley Medical Group, said, "The public regulatory function should assure basic consumer protections, intervene when the market fails, and set common standards and fair rules, but it must also let the private sector innovate and compete." IHA is a statewide leadership group of health plans, physician groups and health care systems, plus academic, business/purchaser and consumer representatives (IHA release, 3/2).