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Home > Resources > eNews > July 2000 |
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The Managed Care Insider eNews Volume Two Number 6 July 2000 PART ONE of TWO Welcome to The Managed Care Insider eNews. You are receiving this because you have subscribed; the eNews is never sent unsolicited. Subscribe/unsubscribe information can be found at the end of this eNews. The Managed Care Insider eNews is published, copyrighted, and owned by The Scheur Management Group, Inc. (SMG), http://www.scheur.com and is distributed monthly, free to subscribers. If you wish to forward this edition, you may do so only if the edition is forwarded in its entirety. No reproduction of any part of this publication is permitted without the express permission of the publishers. ---------------------------------------------------------------- The focus of this issue of the Insider eNews is health care delivery: Can we continue to stand and deliver? Is it a matter of conscience or conviction or control? Specifically, this issue addresses the close to 1,000,000 abandoned seniors who will no longer have access to Medicare+Choice programs through managed care organizations. Shall we complain, or be compliant? Shall we continue to care or care to continue? As always we invite you to send us your comments to insider@scheur.com. This issue also features a reader's response to our June Issue in which our reader expresses his views on the purchase of health benefits. ---------------------------------------------------------------- Insider Vision By Barry S. Scheur, President, Scheur Management Group; Chairman, Venture Health Partnership Group Stand and Deliver: Is the Government Killing Medicare+Choice? Close to one million and counting. An impressive number. These are seniors who have been cut off from Medicare HMO benefits due to a flawed benefit package that is costly for managed care organizations (MCOs) to administer and to a bureaucratic federal program that seems to be more concerned with control than care. It is a program that makes it impossible for MCOs to cover pharmacy benefits -- one of the main reasons for its creation -- and a reimbursement model that hasn't kept up with spiraling costs. If you ever wanted a more accurate parody called "fifty ways to kill a program," it would be Health Care Financing Administration's (HCFA) bungling of the managed Medicare program. Instead of looking at other opportunities to administer a health benefit package to a large group of citizens that would be less costly and more reasonable, HCFA is allowing the MCOs to be the scapegoats for the mismanaged program while it abandons a sinking ship. But who loses? People -- 934,000 seniors, according to the latest count -- and ultimately the managed care industry that yet again is perceived as a money-grubbing group interested in fees, not care. Not true! Any business, even the U.S. government, needs to make a reasonable return on investment for services rendered in order to stay in business. MCOs cannot raise taxes or fees to pay for covered health care services provided to a population noted for long-term chronic illness -- services that are both expensive and needed! Instead, administrative bureaucracy, rigid control over marketing and verbiage, inane review of collateral material, and other absolutely mundane and absurd non-essential by-products of this health benefit package are what our HCFA leaders seem most concerned with, as if those items provide good care. Yes, we need truth in advertising and marketing. Yes, we need non-discriminatory packaging and sales where it concerns the marketplace - but all markets, not just seniors. Yes, there needs to be regulatory and compliance oversight, but not to the present extent and not duplicative of other oversight processes such as those of state insurance departments. Who wins with the current approach? No one! This reinforces my belief that all of us, including the largest federal health care agency, have forgotten that the primary reason for providing managed Medicare benefits, quality care with expanded benefits at an affordable price, is the patient. As each Medicare MCO has to look internally and consider its commitment, convictions and conscience in abandoning the elder portion of our population, so should HCFA look within to make cost-cutting changes -- changes that allow for appropriate reimbursement and are managed by experts who know how to provide access to quality care and pay attention to cost centers. Just as the Bill of Rights confirms certain inalienable choices for each citizen, so should there be the unqualified opportunity to live each day, in wellness and health, without fear of bureaucratic runarounds or restrictions that become barriers to needed medical care. Will we be any better off when the Medicare+Choice program is a forgotten memory? When patients are left with fee-for-service Medicare for which they must buy expensive and non-comprehensive supplements, forego preventive and wellness benefits and coordinated services, and face the decision of whether to eat or get needed treatment? I don't think so, and both political parties and the executive federal bureaucracy should be ashamed. One Company's Stand Venture Health Partnership Group (VHPG) is a new company, dedicated to reforming the managed care industry with actions, honesty, and service. Our two plans have participated in the Medicare+Choice program for many years, providing services to some 33,000 enrollees. We have chosen to stay in this program, even at the risk of severe financial losses next year, while HCFA and the leadership of the Republican and Democratic parties offer strident rhetoric but no real solutions. Why? Because I believe it is unconscionable to abandon this segment of the population when we have worked so hard to educate them, and when they have begun to recognize the value of a coordinated approach to health care services without huge out-of-pocket expenditures or financial uncertainty. We are standing our ground, optimistic that the marketplace, if not the regulators, will recognize the difference between a Wall Street-driven approach to health care and a community-based one. Perhaps I'm being naive, but we have to take a stand and start somewhere. ---------------------------------------------------------------- The complete version of Mr. Scheur's above Insider Vision article which includes his "Dirty Dozen" Solutions to streamline the fiscal and care efficiency practices that senior consumers need and deserve appears in the July/August issue of The Managed Care Insider, SMG's print bimonthly newsletter. To obtain a copy of "Stand and Deliver: Is the Government Killing Medicare+Choice?" and the "Dirty Dozen" Solutions, visit this URL, http://www.scheur.com/1Technology/webpage/EZine.nsf/psub?openform, to complete and submit the free subscription form. Alternatively call Judy Jaffe at 617-969-7500, extension 728. ---------------------------------------------------------------- What's New? Gotta minute? We need YOU to visit our archive page, scroll down, and RATE US, please. Go to http://www.scheur.com/smghome.nsf/webcontent/ezinearchives.html. Thanks! ---------------------------------------------------------------- Sites and Sounds on the Internet: SMG has no ownership of, nor does it endorse the following sites. This information is presented as a resource for subscribers. In keeping with this issue's focus on Medicare+Choice, we present the following sites which cover this area. Health Care Financing Administration (HCFA): Learn all about the Medicare+Choice cutbacks and pullouts at http://www.hcfa.gov Veterans Benefits Administration at http://www.vba.va.gov Email addresses of Congress by zipcode or name: http://congress.org/elecmail.html OR find the Congressional Directory at http://congress.org/congdir.html Health and Human Services, the Office of Donna E. Shalala: http://www.hhs.gov ---------------------------------------------------------------- End of PART ONE of TWO, The Managed Care Insider eNews, Volume Two, Number 6. Scheur Management Group (SMG) is one of the most experienced specialized healthcare operations management and business revitalization consulting firms in the country. Our expertise is in time-sensitive analyses, strategic business and market planning, operational re-engineering, and communications, as well as implementation of start-ups, expansions, and new products. The firm's clients cover the spectrum of insurers, managed care organizations, physician groups, integrated delivery systems, hospitals, employers, governmental entities, vendors, and other providers. Contributing to this edition is Barry Scheur. Editing and Research by Judith Jaffe. Production Coordination by Nancy K. Belle. TO SUBSCRIBE: visit http://www.scheur.com/smghome.nsf/webcontent/ezine.html or send e-mail to insider@scheur.com with the word SUBSCRIBE in the subject and name, email, company, title, and country in the message. TO UNSUBSCRIBE: send email message to insider@scheur.com with the word UNSUBSCRIBE in the subject. Please take a minute to visit our eNews page at http://www.scheur.com/smghome.nsf/webcontent/ezine.html for archives, subscriber information and to RATE our ezine. Get up-to-the-minute health care news on-line at www.scheur.com Go to July 2000 Part 2 |
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