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American Morning
New Approach for HMO's in California
Aired July 11, 2001 - 10:36 ET
THIS IS A RUSH TRANSCRIPT. THIS COPY MAY NOT BE IN ITS FINAL FORM AND MAY BE UPDATED.
THIS IS A RUSH TRANSCRIPT. THIS COPY MAY NOT BE IN ITS FINAL FORM AND MAY BE UPDATED.
DARYN KAGAN, CNN ANCHOR: President Bush plans to announce soon a plan to give older Americans a break from the high cost of prescription drugs. He is expected to propose pharmacy discount cards tomorrow when he outlines his vision for Medicare reform. According to White House officials, the Bush administration believes the plan does not need Congressional approval and that it could be implemented within several months.
Well, now on to Blue Cross of California. It is changing how it rewards doctors participating in its managed care program. The HMO says that bonuses will be determined by patient satisfaction rather than how well doctors keep treatment costs down.
Andre Moreau of our affiliate KCAL has more on this new policy.
(BEGIN VIDEOTAPE)
UNIDENTIFIED SPEAKER: Know how much deep the dissatisfaction is.
ANDRE MOREAU, KCAL REPORTER (voice-over): The announcement is getting major media attention. And it's getting reaction from the most important source, you.
UNIDENTIFIED WOMAN: I think it's a step in the right direction.
MOREAU: The step is Blue Cross' decision in its HMOs to reward their doctors for the way they care for patients, not the way they simply control the cost of the treatment, proving, perhaps, the overly cost conscious way of thinking is now costing more.
JOHANNA RHODES, HMO PATIENT: I think that they're difficult. I think that, you know, you don't have a choice and to be honest, I don't really trust them. I'd rather just not go to the doctor and just use the old school remedies.
MOREAU: Johanna Rhodes' HMO experience seems to be the HMO experience of millions. Dr. Peter Weiss briefly used HMOs in his practice but then stopped. He's not surprised about the BCC announcement, but says it could have come before now.
DR. PETER WEISS: I think what's happened is that enough patients have finally complained. They've had enough. We, I know, as physicians have had enough for a long time. And I think they've truly recognized that it's not in their financial interests to continue the practice that we're doing. So I think they've sort of been forced by the patients.
MOREAU: BCC insists patient care has always been first.
DR. STEVEN DEUTSCH: So often when patients come into the office they're so concerned that something is not going to be done on the basis of cost, where that is just not what happens, but that is the perception. They read the articles in the media and they're so more frightened than they are anything else.
MOREAU: Perception or reality, patient care is getting noticed. In Washington, there's patients' rights legislation in the works. BCC says its new program isn't in response to that, but it would be hard pressed to prove that to someone like Johanna Rhodes.
RHODES: Now, you're talking about people's lives and their health and it's better if you feel that you can go to doctor and you have a confidence in him, then of course you will go. But if you have no confidence, then you're going to, you know, people don't want to be sick and then denied things anyway. So if you feel like you can go and you can trust your doctors to be honest with you, then you'll go.
(END VIDEOTAPE)
KAGAN: More on this story now. Dr. Mike Bellman is a medical director from BCC of California and he's joining us now from our Los Angeles bureau.
Dr. Bellman, good morning. Thanks for joining us.
DR. MIKE BELLMAN, BLUE CROSS: Thank you. A pleasure to be here.
KAGAN: Why now? Why make this change?
BELLMAN: Well, this change has been some time in the making. It was announced yesterday, but we have had a program in place for some years. This is now a radical reexpansion of our current program where we were contributing a considerable sum of dollars towards physician and medical group bonuses in California.
KAGAN: Explain to me how you measure patient satisfaction.
BELLMAN: Well, we have a survey. This is a survey that has been developed by academic researchers over several years. It's the same survey that's used by the Pacific Business Group on Health, which is a large health care consortium in California representing many large employers. And the questions have been well validated in several field surveys. So we feel very comfortable with the survey, and it covers areas where the patients and physicians interact, how the patient feels with the physician, whether the physician communicates, explains the disease, and we think it gives a very good reflection of that interaction.
KAGAN: But just because a patient is satisfied, does that mean that they're getting good medical care?
BELLMAN: No, and that's an appropriate question in the sense that we are also concerned about the management of the patient's health. And so there are several components of the score card which deal with the management in that area. That is, we are looking at preventive care such as mammograms, pap smears, management of childhood immunizations and things of that nature. And in addition, looking at the management of chronic diseases, for example, asthma, if that's being managed appropriately. And there are several...
KAGAN: Dr. Bellman, I'm sorry to interrupt you.
BELLMAN: Yes?
KAGAN: It's just that our time is so short. I'm sure it's not news to you that when it comes to HMOs and medical care, people are very cynical and doubtful, especially of new announcements like this, and there are going to be the cynics out there that say that BCC is simply doing this because they know some strong legislation is coming down the pike and it's just a preemptive strike.
BELLMAN: The announcement came coincidentally. As I say, we have had a program in place for several years. The expansion has occurred. The planning has been several months in effect. So this is coincidental that it occurs now with the current discussion in Washington. I should also add that the legislation in California, which is already in effect, already covers much of what is being discussed in Washington. So we don't see that the patients bill of rights is going to make too radical a difference for us here.
KAGAN: Do you think, expect it to spread, though, to other HMOs?
BELLMAN: Are you talking about our program?
KAGAN: Yes, mm-hmm.
BELLMAN: Well...
KAGAN: With patient satisfaction tied to bonuses.
BELLMAN: Well, we think that the rewards have been out there. We think that this puts more money on the table. But in addition, another component of our program which we believe is unique is that we are removing the rewards for cost containment and saying to physicians that we would like you to take the best care possible of the patients and if you do so, here is a tangible reward for your efforts. We think that this goes a long way, also, to help restore patient trust in the system.
KAGAN: And just real quickly as we wrap up, does this mean this is going to end up costing the patients and your customers more money, too? BELLMAN: Not at all. This is a redirection of current premium dollars so that we are taking those dollars and putting them to the use of the medical groups and physicians in California to provide the optimal care.
KAGAN: Dr. Mike Bellman, good luck with making the folks in California happy.
BELLMAN: Thank you very much.
KAGAN: Thanks for being with us.
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