PHYSICIAN-DIRECTED TEAMS: NM HMO Opens Gate Wider
In what some are calling "the next step in the evolution of managed care," Presbyterian Health Plan, New Mexico's largest HMO, is instituting a new gatekeeper system under which "primary care doctors will determine what specialists patients should see -- and when -- rather than the HMO." The Albuquerque Journal reports that the so-called physician-directed teams "will have authority in most cases to contract with specialists they choose, regardless of whether those specialists have contracts with the health plan." Presbyterian President Dr. David Scrase said placing more of the decision-making in doctors' hands should make for better physician-HMO relations. "They no longer are an enemy of managed care. They see it as their own structure, and they make decisions based on what they feel is appropriate. ... They are now accountable." But, the Journal reports, "with the added authority ... comes additional risk," as each team will have a budget from which it will be responsible for paying specialists. Dr. Harvey White, president of Southwest Cardiology, said, "It's good news, at least for some of the patients, that they'll have a little bit more choice. But it's sort of pseudo-choice. ... Patients have to recognize that who they're going to see as a cardiologist is dependent on who they choose as their primary care physician. They're going to have to work backwards, and it puts them in kind of a bind." The Journal reports that the new policy, effective Jan. 1, will affect some 84,000 people, about 70% of Presbyterian enrollees (Sedrel, 12/6).This is part of the California Healthline Daily Edition, a summary of health policy coverage from major news organizations. Sign up for an email subscription.