"There's a growing concern about managed care and its impact on quality," says Ruth Rogers Bauman, vice president for actuarial and underwriting services with HMO Oregon, a 450,000-member HMO with its base in Portland.
says people often forget that there are probably as many medical accidents under other systems as there are under managed care.
"We heard about those for years under fee-for-service, but they didn't blame it on the payment mechanism.There's not a lot of proof that it happens more under managed care.Not doing things can often be helpful, and doing more can be harmful," Bauman
But taken from a national perspective, says managed care analyst Boland, the campaign was not surprising.The Oregon anti-capitation initiative reflects a growing national discontent with managed care, manifested in the passage of a number of state laws to regulate the industry.Add to the mix the loss of jobs due to hospital downsizing and medical-office and health-plan consolidation and the climate becomes even more politically volatile, he
says HMO Oregon
took a neutral stance vis-a-vis the anti-capitation initiative because it didn't want to appear self-serving and because capitation is just a small part of its strategy."We don't use capitation very much," she
says."It's not the only way to do managed care."However, the HMO recently offered a new capitation model for its over-65 population, setting aside part of the capitation for an incentive fund keyed to patient satisfaction scores.
"If anti-managed care moves are going to be headed off, employers are going to have to say capitation helps cut costs," says Bauman
."Physicians are going to have to speak up and say we can treat patients well under a capitated managed care system," she
says, citing the example of her
own physician, who claims to feel freer under capitation because she
doesn't have to follow the rules of any health plan.
HMOs could emphasize what they do to measure quality and monitor underutilization and patient satisfaction, and how they serve as a watchdog over capitated medical groups.Do they just give them the money and walk away or do they act as ombudsmen protecting the interests of patients?Answers to questions like that can help offset Aunt Maud's negative anecdote.
"If you're satisfying members and holding down costs, voters aren't likely to want to change the system," concludes Bauman