MANAGED CARE: USA TODAY SALUTES DIRECT ACCESS

      A USA TODAY editorials commends those HMOs that are "taking
 the edge off their rigid" specialist referral policies.  The
 editorial states that the direct access policies adopted by some
 plans, which allow members to see "in-network specialists" for an
 added fee, come "not a moment too soon" because the "rising
 public clamor about tightfisted health plans is beginning to
 attract the attention of state Legislatures."  According to USA
 TODAY, "[I]f HMOs don't begin to answer the frustration of their
 members, politicians are likely to do it for them."
      SPLIT THE DIFFERENCE:  USA TODAY notes that the "more
 limited forms of direct access" already used by health plans are
 only "compromises" of the traditional managed care model:   
 "After the first visit, most care still must be pre-approved by
 the HMO."  The editorial notes that the "traditional alternative"
 for many health plan members, the point-of-service option, "comes
 with significant out-of-pocket costs, putting it beyond the reach
 of many consumers."  Therefore, direct access to in-network
 specialists is "one intriguing way to split the difference" on
 other more restrictive policies.
      HONOR ROLL:  USA TODAY applauds three managed care plans for
 implementing new direct access policies:  Blue Shield of
 California for allowing their patients to self-refer to
 specialists (see AHL 6/18); Santa Barbara, CA-based Monarch
 Health System for allowing their primary care doctors to refer
 patients to specialists without pre-approval; and Minnesota-based
 United HealthCare for allowing enrollees "to see network
 specialists whenever they wish" (6/25).