THE VIRGINIAN-PILOT
Copyright (c) 1995, Landmark Communications, Inc.
DATE: Monday, December 18, 1995 TAG: 9512160168
SECTION: BUSINESS WEEKLY PAGE: 04 EDITION: FINAL
COLUMN: Career Track
SOURCE: BY SANDRA W. BRANDT, SPECIAL TO BUSINESS WEEKLY
LENGTH: Medium: 97 lines
Editor's note: Managed care will be a health care issue when the Virginia General Assembly convenes in January. Here, Sandra W. Brandt puts the matter in perspective and outlines what she'd like done. Brandt is treasurer of STEP-UP Inc., a training and placement agency in Suffolk, and serves on the health care committee of the Hampton Roads Chamber of Commerce.
As a small business owner and one who provides health care plans to my employees, I look for two major provisions. First, health care plans have to offer quality care for my employees and second, they should be affordable.
But looking at these two issues and comparing health care plans can be confusing.
When renewel time approaches for our company health plans, I review a variety of plans and build a comparison of each plan to the other. This is almost as bad as comparing cost items in the national budget process.
What does one have that the other ones doesn't? Is this one an HMO (health maintenance organizations) and can I still go to my doctor or is he/she not included in the network?
Next, I review a PPO (preferred provider organization) that offers a variety of physicians and services. But, does my physician belong to the service listing or do I need a referral from one doctor to my doctor?
Finally there is my old plan which I have been in for a couple of years. I can go to the physician of my choice, see my regular doctor and don't need a referral. Now, the cost for my old plan is a few dollars more than the other plans.
So, where am I now? Back where I started, looking for quality and affordable health care.
How do my two major considerations - quality and affordable health care - factor into what is happening at the state level? And can I expect to see additional changes in the 1996 Virginia General Assembly.
Managed care will be the health care issue at the state level. But what is managed care?
It is a term used to describe a variety of health care delivery systems that are organized to enhance quality and cost effectiveness.
It involves different types of providers that agree to provide services to those covered under the plan. The providers are typically insurance carriers, employers, physicians, and/or hospitals.
The payments made typically involve incentives to control costs.
An employer may have one of the plans such as HMOs, PPOs, point of service (POS) or a mixture of these and other plans.
Some other features of managed health care are able to eliminate the unneccessary, wasteful care, including duplicative tests and multiple uncoordinated self-referrals to specialists, and engage in the development of quality assurance programs that will allow employers and employees to make plans accountable for both the cost and the quality of care being provided.
Also, the lower costs associated with the plan is because of the emphasis placed on preventive care and early detection This also has a direct bearing on the quality of care.
Why should employers be involved in managed care plans? Because it offers employees and employers a cost advantage.
The advantages are high-quality physicians and other health care providers, including hospitals. In addition, providers give employers plans that offer discounts off their usual fee and offer patients strong financial incentives such as lower premiums and lower out-of-pocket costs while, at the same time, offering quality care.
Legislation passed in 1992 enhanced the availability of health insurance for employers of two to 49 employees.
Employers can anticipate that this legislation will be changed to include employers of two to 100. This change is due as a request from businesses to be able to include employees who move from an employer of one size to an employer of another size.
Currently, 38 states have included portability provisions in their small-employer health insurance plans.
These provisions require insurance carriers to waive pre-existing condition limits or waiting periods if an individual had been continuously enrolled in a health plan.
This is an area that will be reviewed by the assembly. The issue of giving employees credit towards any waiting periods imposed under the new employer's policy when moving from one insured employer's plan to another also will be considered. Nationwide, over 20 million Americans changed jobs in 1993.
This would have a direct effect on those individuals who want to change jobs but are afraid that they would lose insurance coverage and pre-existing conditions when making the change.
Other issues that I would like to see considered would be plans that offer employees incentives for insurance coverage that is less expensive but easy to obtain, especially for those employers who want to provide the benefit but cannot afford to do so.
Also, programs that would allow for the development of small business insurance risk pools. And, a 100 percent tax credit deductibility for health insurance expenses for all businesses.
Am I asking too much, as a small business owner? I think not, but then, isn't Christmas the time to have visions of sugarplums and reasonably priced, effective health plans. by CNB