Managed Care - March 2009 - (Page 45) PLAN WATCH group pays for and installs it. “We have KP HealthConnect fully implemented in every physician’s office,” says Pearl. “We have it implemented in over half of the hospitals. Our physicians have it on their desktop, they have it in the hospitals, the emergency departments — even in their homes, for some — all the information they need to deliver care to their patients.” Pearl describes a very different reality in the world of consumer health plans. “For example, physicians are competing against each other,” he says. “The physician is fighting with the hospital. Everyone’s fighting the insurance companies. Whereas in an integrated organization, we all work together for the greater good of the patient. That’s a very different experience, and it’s far more satisfying both professionally and personally.” The bottom line, he admits, is the amount of premium patients and purchasers are willing to pay. “However, what is different is that in the feefor-service world, the physicians ask how can they personally earn more money, the hospitals ask how they can earn more income for their institution and the for-profit health plans ask how they can generate higher stock prices for their shareholders,” says Pearl. “Often that leads to dysfunction and underperformance.” Everybody’s happy Not that stockholder-owned health plans can’t learn from how the Permanente Medical Group operates. Happy doctors mean happier patients and better performing health plans, says Pearl. “On a California state survey [2008 Report on Quality by the California Cooperative Healthcare Reporting Initiative (CCHRI)], we were number one in 34 out of 40 categories.” Still, the Permanente Medical Group’s success could be difficult to replicate for the for-profit organizations. “Their primary obligation is to their shareholders, as opposed to their patients,” says Pearl. “So I think there is an intrinsic conflict and they are not likely to adopt the kinds of approaches that have proved so successful at Kaiser Permanente.” Arthur N. Leibowitz, MD, the executive vice Kaiser keys on communication primary care physician’s role as gatekeeper is not so pronounced as it once was, thanks to things like point-of-service plans and health savings accounts. Still, the PCP’s importance to managed care should not be underestimated. There are about 36,000 PCPs in California, and if they are not happy with one of the health plans in that state, chances are that their patients won’t be happy either. A Practice size and access to technology Electronic access to diagnostic test results Solo Small/Medium Large Permanente 19% 38% 69% 95% Receipt of patient test result alerts Solo Small/Medium Large Permanente 10% 9% 33% 62% Receipt of drug dose/interaction alert Solo Small/Medium Large Permanente 9% 22% 38% 73% Source: “Uncoordinated Care: A Survey of Physician and Patient Experience,” California HealthCare Foundation, 2007 president and CMO of Health Advocate, a company that helps consumers and employers navigate the often choppy waters of managed care, warns that nothing is ever black and white. “Certainly those doctors in staff models often gravitate there because they are interested in the relatively secure life that such positions offer, but you find unhappy people at Kaiser and happy people in Cigna’s network, so it’s a difficult generalization,” he says. MC MARCH 2009 / MANAGED CARE 45
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