America's Best Health Plans
Managed care doesn't have to be cold and uncaring. The highest-ranking plans have a positive attitude.
How is it possible that some people never seem to get sick? Good genes, good fortune, good karma? Whatever it is, Lori Rittenhouse wouldn't mind having some. The 35-year-old mother of three has had asthma since childhood. Three years ago she was diagnosed with diabetes and a month later discovered she was pregnant. That called for a drug and diet high-wire act to harness her blood sugar without harming or undernourishing her fetus. Hypertension and high cholesterol round out her litany of health problems.
Without careful monitoring and regular medical attention, Rittenhouse could easily wind up in a hospital near her suburban Wilkes-Barre, Pa., home with flare-ups or complications. But she's lucky: She's a member of Geisinger Health Plan, which covers much of central Pennsylvania. It's one of the biggest rural plans in the nation and among the top 20 commercial plans in new rankings assembled by U.S. News and the National Committee for Quality Assurance, the major accrediting body for managed-care plans.
Keeping tabs. One of Geisinger's distinctions is its disease-management program, which monitors and assists members like Rittenhouse with chronic health conditions. A nurse in the program has been keeping close tabs on her for four years. After helping her quit smoking, now the nurse focuses on making sure she's taking her medications and keeping up with regular blood tests and eye and foot exams for her diabetes.
If Rittenhouse has a question for her primary-care doctor, she logs into the Geisinger system from home and sends her an E-mail, eliminating the telephone tag they used to play. And she can view her patient record online, including test results and weigh-ins, which she charts in graph form on her password-protected page. "They keep so on top of me, it makes me feel more comfortable," she says. "I don't worry as much."
These days, a satisfied managed-care member seems about as rare as a flattering hospital gown. Faced with rising premiums, employers continue to shift healthcare costs onto their employees' shoulders, and workers are scrambling to pay the bills. In 2005, premiums rose 9.2 percent, slightly less than in previous years but more than three times the growth in employee earnings, according to the Kaiser Family Foundation's annual Employer Health Benefits Survey, released last month. Workers paid $2,713 on average in premiums for family coverage in 2005, nearly $1,100 more than five years ago. And that represented only about 26 percent of the total cost; their employers picked up the rest. Deductibles, copayments, and coinsurance have climbed.
If managed care today seems more about managing costs than providing care, consumers are at least partly to blame, say health policy experts. When managed care first became widely popular, in the late 1980s and early 1990s, it offered consumers a trade-off: In exchange for richer benefits (such as full coverage of preventive care) and much lower out-of-pocket costs ($5 or $10 copayments), consumers agreed to allow plans to coordinate and sometimes limit the care they received. People liked the cheap, comprehensive benefits. But by the late 1990s, managed care's "gatekeeper" function had provoked a huge backlash among patients--and doctors, who felt their authority had been usurped and their expertise challenged.
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