Meet the New Doc

NOW THAT MINNESOTA'S vaunted health care reform has produced unprecedented consolidation of the market around three or four huge managed care companies, influential players in both the private and public sector are trying to undo the damage.

The Buyer's Health Care Action Group, which negotiates health coverage for more than 200,000 employees from 23 large local corporations and the state of Minnesota, is readying itself for a massive effort to give individual consumers more choices, more information, and, not incidentally, more responsibility for the costs in the system. "The key customer shouldn't be the employer at the wholesale level, it should be the employee at the retail level," says BHCAG Executive Director Steve Wetzel. "We want to create more accountability between the doctor and hospital groups and the individual patients." To that end, BHCAG plans to begin implementing a system next January that gives patients a health care budget (similar to a stipend or a voucher), provides them with more information on the cost and quality of various doctors and hospitals, and allows them to contract for services directly.

Meanwhile, representatives from the Minne-sota Association of County Social Service Admin-istrators will appear today before the Health Committee chaired by Senator Linda Berglin at the State Capitol in an attempt to generate a more flexible and collaborative model for their health services. Berglin is particularly concerned about improving mental health coverage for children and resolving other gaps in the system. She cites a recent independent report by Allan Baumgarten, formerly of the Legislative Auditor's Office and the Citizens League, showing that Minnesota's managed care companies recorded more than $18 million in excess revenues from the government's General Assistance Medical Care program in 1994, and that the bulk of their total revenues were made through traditional fee-for-service style medical insurance practices. "If all the managed care networks are doing is squeezing [doctors and hospitals] and limiting access to services, well, the Legislature already knows how to do that," Berglin says.

Wetzel and Berglin are acknowledging that the centralization of the state's health care system has not produced the kind of cost-effective and quality-oriented care one would want; this is significant, and more than a little ironic, because two of the catalysts for this corporate consolidation were the formation of BHCAG and the passage of MinnesotaCare, the state-sponsored health insurance program that Berglin coauthored. But activists on both sides of the political fence know the managed care status quo is strong; even BHCAG's bargaining clout won't be enough to fundamentally change the marketplace.

First, there are concerns about how relevant and useful "consumer information" will be when a patient is shopping for a doctor or a hospital. "The Minnesota Health Data Institute did a million-dollar patient satisfaction survey about health plans last year that was probably the most sophisticated thing anybody has done in the country, and it's useless--the difference in satisfaction between the main plans was within the survey's margin of error and the questions they asked did not get at quality of care," says Kip Sullivan, research director for Minnesota COACT.

"If your employer pays the deductible, the facilities are accessible, and you don't have a chronic condition, you are probably going to say you are satisfied. But that doesn't begin to address the quality of any of the 7,500 medical procedures you may need. Gathering and assembling that much detail for each plan just isn't practical." (Ted Wise, the senior vice president in charge of this "consumer choice system" developed by the managed care company Health-Partners in response to BHCAG's request, admits that most of the information in the system is currently restricted to addresses and office hours, along with a self-supplied description of each facility.)

Meanwhile, the consolidation by the major health care players of their oligopoly continues. In the words of Dr. Steve Brzica, a member of the physicians' lobbying group HealthPAC, "The horse is out of the barn too far in this market for even the Wetzels and the Berglins to control."

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