SACRAMENTO-A California HMO task force has found 100 ways to reform the state’s managed-care industry.
Leading the state advisory body’s nonbinding recommendations is the formation of a new agency to regulate the industry, replacing the Department of Corporations. Other measures include improved patient-grievance procedures, easier access to specialist care, and risk-adjusted payments to doctors who care for sicker patients.
Chaired by Stanford economist Alain Enthoven, the managed-care guru, the task force was appointed by Republican Gov. Pete Wilson and state lawmakers last spring in response to a flood of reform bills introduced in the legislature. Wilson threatened to veto any enacted before the panel’s final report.
Critics said it wasn’t worth the wait. They branded the panel’s 100-point wish list a weak prescription for the industry and said they would seek tougher legislative reforms or voter initiatives.
Chiropractor Martin Gallegos, an assemblyman and member of the task force, called the recommendations “industry-dominated and rather soft.” A Democrat who chairs the Assembly’s health committee, he vowed to draft a constitutional amendment to make HMOs more accountable.
Jamie Court of Consumers for Quality Care complained that the task force didn’t even address two of the industry’s major problems-capitation and accountability. The California Medical Association, which saw many of its suggestions unaddressed, such as an end to arbitrary deselection, praised the panel for its stances on risk adjustment and access to specialists.
But, said Dr. Rolland Lowe, CMA’s president, it “did not go far enough in other critical areas, including health-plan accountability.” -Judy Ismach
SACRAMENTO-A California HMO task force has found 100 ways to reform the state’s managed-care industry.
