MEDICARE HMOS: AVERAGE DISENROLLMENT RATE ON THE RISE

      The average national disenrollment rate for Medicare HMOs
 rose to 13% in 1996, up from 11.2% in 1995, according to the
 first-ever disenrollment study of the nation's Medicare HMOs"
 released this morning by Families USA.  According to the consumer
 group, the percentage of Medicare recipients leaving their HMOs
 "varied dramatically" from plan to plan and state to state last
 year.  PCA Jacksonville (FL) had the highest disenrollment rate,
 with 81.1% of its average enrollment leaving the plan in 1996. 
 The lowest rate (2.4%) was registered by Fallon Community Health
 Plan in Massachusetts.  "The plan-by-plan comparisons of Medicare
 HMO disenrollment rates are an important consumer resource that
 should be made available to Medicare beneficiaries.  HMOs with
 high quit rates often mean that plan members expressed
 dissatisfaction with their feet, and prospective enrollees better
 beware," said Families USA Executive Director Ron Pollack.
      VARIED FINDINGS
      According to the Families USA survey, 28% of Medicare HMO
 enrollees who voluntarily quit their plans in 1996 did so either
 before their enrollments became final or within the first three
 months of enrollment.  The group said these rapid disenrollments
 could indicate HMO marketing problems, ranging from "slick
 marketing with inadequate information to outright deception." The
 highest disenrollment rates were found in Washington, DC (31.6%),
 Florida (25.3%), Kentucky (21.8%) and Texas (19.4%).  The survey
 found that six out of the 10 Medicare HMOs with the highest
 disenrollment rates were in Florida, three were in Texas and one
 was in California.  The 10 plans with the highest quit rates had
 an average disenrollment rate of 53.6%.  The 10 plans with the
 lowest quit rates had an average disenrollment rate of 3.7%. 
 Families USA notes that of the 10 plans with the lowest
 disenrollment rates, nine are nonprofit HMOs; while seven of the
 HMOs with the highest disenrollment rates were for-profit.  The
 survey looked at all 158 Medicare HMOs in operation throughout
 the 1996 calendar year; each plan had a minimum Medicare
 enrollment of 1,000.
      REVOLVING DOOR?
      The Families USA survey looked at the market impact of
 Medicare disenrollment in Texas and Florida, finding that all
 five Texas plans with disenrollment rates above 20% last year
 experienced a net gain in members and market share.  Of the 14
 Florida plans with disenrollment rates above 20%, nine saw a net
 gain in Medicare membership and five gained market share.  "Some
 of the plans with the highest quit rates are churning members in
 and out with recruitment outpacing disenrollment.  This revolving
 door for Medicare members is a clear sign that improved national
 oversight of health plans is necessary so that unsuspecting
 beneficiaries are not put in harm's way," Pollack said.
      DANGER SIGN
      Families USA Director of Health POlicy Geri Dallek said the
 survey findings underline the need to provide Medicare recipients
 with more information about health plans.  "As the balanced
 budget act of 1997 limits disenrollment rights for Medicare
 beneficiaries by the year 2002, the publication by HCFA of
 disenrollment data will be increasingly important. ... We hope
 that this report demonstrates that this information can be made
 available in a way that provides consumers with much needed
 information as they choose a Medicare HMO" (Familes USA release,
 12/4).
      PUT IT IN CONTEXT
      American Association of Health Plans spokesperson Susan
 Pisano said "one important fact was left out" of the Families USA
 survey.  "If you look at the percentage of beneficiaries who are
 leaving HMOs, only three percent on average are" returning to
 fee-for-service Medicare.  "So there is a very, very high level
 of satisfaction being expressed with health plans," she said. 
 Pisano emphasized that AAHP members are "strong advocates of
 patients having information on a number of measures."  But she
 emphasized that such information "should be used with caution"
 and put into "context."  She said disenrollment rates often
 "reflect choice of health plans in a particular community" and
 that "if consumers are given choice and competition works,
 consumers will exercise their choice by switching plans." 
 Underlining the context issue, Pisano said, "It's just as
 important to know why somebody disenrolled as knowing the
 disenrollment rate" (American Health Line sources, 12/4).