Clinton Praises HMO’s Move

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Orlando Sentinel

United Healthcare Corp.’s groundbreaking decision to give doctors final authority over patient care won high praise from President Clinton on Tuesday and will likely give the health insurer a key marketing edge with consumers.

United, the nation’s second-largest health insurer, eliminated one of the most unpopular elements of managed health care Monday when it gave up the power to preapprove medical care and said it will no longer overrule decisions of doctors. United has 93,000 customers in Central Florida.

Analysts had mixed opinions on whether the rest of the industry would follow suit, even as one large insurer said it would continue reviewing doctors’ decisions.

Many managed health care plans rely more heavily than United on scrutinizing the day-to-day decisions of doctors and may fear costs will skyrocket if they relinquish control, some analysts say.

“Some HMOs are scared that they can’t control the doctors,” said Peter Boland, a health care management consultant in Berkeley, Calif. “They see this as contrary to their control and command philosophy.”

But other analysts think United’s rivals will be forced to dismantle their own oversight policies in the face of rising political and public pressures.

“Other health maintenance organizations are going to have to follow suit, or they’re going to be ostracized,” said Jamie Court, a consumer advocate based in California.

Most large insurers said they needed more time to review United’s policy changes before commenting on their own plans. However, Jose Marques, a spokesman for Humana Inc., said the company expects to continue reviewing doctor decisions and referring disputes with doctors and patients to independent physician committees.

“Our responsibility is to manage the care that our patients receive,” he said.

Likewise, Aetna, the largest health insurer, has a reputation for keeping a close watch on physicians and is unlikely to ease up on the reins, Boland said. An Aetna spokeswoman said the company has not seen details of United’s strategy change and could not comment.

Matthew Davies, chief executive of United’s Central Florida division, said the insurer implemented the new policy in the region in early October. Local doctors no longer have to check in with the insurer for treatments that were regularly approved by the insurer, he said.

As a result, calls from physicians to the company’s Orlando call center have dropped off significantly.

Some jobs at the call center were eliminated because of the changes, Davies said, although he would not give a specific number. The center’s 23 remaining employees are being retrained to handle other duties, he said.

United’s new policy allows the insurer to focus on saving money in other ways. For instance, United will pay closer attention to patients who aren’t refilling critical prescriptions or visiting their doctors regularly.

“To the extent that we can prevent a patient from re-entering the hospital, which can be very expensive, we’ll be saving money,” Davies said.

Clinton, who supports federal legislation allowing patients to sue their HMOs, complimented United. “Good for them. I applaud them,” he said. “And they’re large enough that they might really be able to do it and have an impact on this.”

Consumer Watchdog
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