West Coast group will offer managed care alternative

Large employers are motivated by higher premium costs to provide a plan that includes a mix of medical savings accounts and PPOs.

By Myrle Croasdale, AMNews staff. Dec. 17, 2001.

The Pacific Business Group on Health, a corporate group, is signing on with Definity Health to offer an alternative to managed care.

The group's move may accelerate the acceptance of nontraditional health insurance in the marketplace, analysts say, especially in a market scrambling to find ways to fend off rocketing insurance premiums.

For doctors, less managed care may sound like welcome relief. Definity's Breakthrough Plan is a medical savings account wrapped around a PPO, which means physicians get their full fee until the savings account runs dry, then the PPO's physician reimbursement rates kick in.

Karen Nikos, spokeswoman for the California Medical Assn., said such alternative health plans are a positive move. "We generally think they're a good idea," Nikos said. Her organization has produced surveys showing physicians suffering under managed care, especially capitation.

The plan the Pacific group is asking Definity to design, however, also will include quality ratings for physicians and hospitals, which raises concerns about how a doctor's performance is measured.

Laura Morasch, director of medical practices for the California Academy of Family Physicians, said this was a worthy challenge. "To define quality is a slippery issue, but it is important," Morasch said. "Ultimately, there needs to be more transparency."

But Nikos said the business group's quality surveys weren't that popular with doctors. "We believe you need to do more than patient satisfaction surveys," she said. "All surveys are important, but you need to weigh other information." [...]