To Sue Or Not To Sue?
Congress is currently considering legislation to give people the right to sue managed care organizations for denied or delayed medical care. While such a law is sorely needed and long overdue, it is not likely to have much impact on the health insurance industry, says Peter D. Jacobson, an attorney and assistant professor in the U-M School of Public Health.
"Neither Congress nor the managed care industry seems inclined to address the deeper problems affecting our health care system," he says, referring to the rising number of uninsured Americans, escalating health care costs and the decline of the public health system. Contact Jacobson by e-mail at firstname.lastname@example.org or by phone at (734) 936-0928 or (734) 769-3432.
"To improve health care, get rid of dueling guidelines," says John E. Billi, M.D., an associate professor of internal medicine in the U-M's Health System. Managed care plans use clinical practice guidelines to determine the treatments and procedures they will approve for specific medical conditions.
The problem is every HMO has a different set of guidelines. Billi is leading a campaign to standardize these guidelines across all Michigan managed care plans. He says this will eliminate the "dueling guidelines" problem in which the level of care you receive for any given illness varies depending on the type of card in your wallet. Plus it will ensure that Michigan HMOs use guidelines based on results from national clinical studies---instead of those developed by a few physicians or one managed care organization. Schedule an interview with Billi by calling (734) 936-5214.
Check Out Your Hmo'S Report Card To Find The Plan That Best Suits Your Needs.
Most major managed care plans have report cards that grade everything from overall quality of care to the helpfulness of the customer service staff. Ask your employer or HMO for a copy. Even though report cards can be very helpful, few employees use them, says U-M School of Public Health economist Michael E. Chernew.
"It's important that people understand the attributes of their health care plan choices. It's very hard to communicate that to people who are getting bits and pieces of information from a lot of different sources,'' he says.
To learn how to use the information on report cards to make an informed choice, contact Chernew by e-mail at email@example.com or by phone at (734) 936-1193 or (734) 994-4645.
Examples of report cards for New Jersey HMOs are available on the Internet (http://www.state.nj.us/health/hmo/hmoreport.htm).
Managed care changes physicians' prescribing habits, but not always for the better, according to Frank Ascione and Duane Kirking of the U-M's College of Pharmacy. Instead of relying on pharmaceutical company representatives for information about prescription medications, managed care organizations are forcing today's physicians to examine their prescribing habits.
While information from managed care firms can be valuable, it's not always objective, since HMOs may promote the use of medications based on cost, rather than effectiveness. And because different managed care organizations recommend different prescription drugs for the same condition---or change recommendations from year to year---the end result has been more confusing than enlightening to physicians. Reach Ascione at (734) 763-0100 or firstname.lastname@example.org. Contact Kirking at (734) 764-4483 or dkirking @umich.edu.
Hospital Pharmacies Balance Costs And Care.
Keeping hospital expenses under control while providing the best medicines for patients is a constant challenge, says Nabil Khalidi, interim director of pharmacy services for the U-M Health System.
Cost is a factor in selecting prescription drugs, but so are a drug's efficacy, the availability of other drugs that do the same thing, and the potential for adverse effects, including antibiotic resistance.
"The fact that a drug is expensive is not necessarily a bad thing," says Khalidi. Some expensive drugs, such as the clot-busters streptokinase and tPA, are literally life-savers. Others actually save money by shortening hospital stays or sparing patients from procedures which are even more costly than the drugs.
Contact Khalidi at (734) 936-8223 or email@example.com.