A study finds fewer complaints about Kaiser-style health plans, in the Healthcare column

PacifiCare Tough Times Aired; Nurses Prep for New Rules

Managed healthcare service plans continue to receive scholarly attention, including a new examination of consumers by a University of California, Berkeley, research team. And their findings seem to stroke health plans that follow the line of Kaiser Permanente, which has approximately 314,000 members in Orange County.

Professor Helen Halpin Schauffler and her colleagues found that health maintenance organizations that follow a staff/group model, like Kaiser, received the fewest consumer complaints. Overall, 34% of members reported problems with a Kaiser-style HMO, compared with 43% for preferred-provider organizations and 46% for network HMOs such as Santa Ana-based PacifiCare Health Systems Inc.

In staff/group model HMOs, doctors see patients from one HMO exclusively. Besides Kaiser Permanente, other examples of the model cited by the researchers include Group Health Cooperative of Puget Sound in Washington state and the former Harvard Community Health Plan in Massachusetts.

The Berkeley group surveyed a total of 1,201 randomly selected adults with health insurance. Overall, they found that 42% of the respondents reported one or more problems with their managed care organization, ranging from billing errors to limited access to specialists to denial of treatment.

As for the other models, PPOs, where doctors contract with insurance companies to provide services at a discounted fee, ranked second in overall consumer problems, according to the study. Researchers found, however, that most reported PPO problems were related to administration issues like billing and understanding benefits, rather than access to healthcare.

Independent provider association/network HMOs, which usually require primary care physicians to act as care gatekeepers, ranked third in the study. Those respondents’ most common complaints involved difficulties in getting referred to specialists and difficulties in selecting a doctor or hospital, according to researchers. They added that network HMO members reported a higher rate of being forced to switch doctors.

Results from the study will be published in the January issue of Medical Care, a trade journal. The California HealthCare Foundation, the California Managed Health Care Improvement Task Force and the California Wellness Foundation provided study funding.

BusinessWeek Airs PacifiCare Ills

Meanwhile, PacifiCare was the subject of “This HMO Needs Resuscitating,” a news analysis in the Jan. 8 edition of BusinessWeek. The piece recaps some of the company’s problems, including being placed under administrative oversight by Texas insurance regulators, shareholder lawsuits and changes in the management suite.

New PacifiCare Chief Executive Howard Phanstiel told BusinessWeek that the company would face a couple of “very tough years” before it could be straightened out. Phanstiel, among other things, told the magazine that PacifiCare was somewhat na