America's Best Health Plans
Managed care doesn't have to be cold and uncaring. The highest-ranking plans have a positive attitude.
The price of choice. Under pressure from employers, health plans backed off. Today nearly two thirds of people covered by employer plans belong to preferred provider organizations, which generally give members access to a wide network of doctors and services without requiring gatekeeper approval. Five years ago just 42 percent of workers belonged to PPOs. Meanwhile, the number of workers in traditional health maintenance organizations, which impose stricter controls, has fallen to 21 percent.
Consumer choice, however, comes at a cost. Yearly premium increases, which had dipped below 1 percent in 1996, peaked at 13.9 percent in 2003."Consumers now have less restrictions on their care, but they're paying a lot more for it," says Paul Ginsburg, president of the Center for Studying Health System Change, a nonpartisan think tank based in Washington, D.C.
The most workable solution, some experts argue, is to turn back the clock. In surveys, a majority of consumers say they would trade less choice of healthcare providers for lower out-of-pocket costs. "When we finally come to our senses, we'll go back to tighter managed care," says Donald Berwick, president and CEO of the Institute for Healthcare Improvement in Cambridge, Mass. But most health industry experts and employers these days are betting on a different remedy to cure our healthcare ills: consumer-driven healthcare.
If PPOs let consumers nibble at making their own healthcare decisions, consumer-driven healthcare lays out an all-you-can-eat banquet. The most-cited model is based on a tax-free health savings account, or HSA. Individuals or plan members open an HSA in which they or their employer sets aside pretax money to cover deductibles and other out-of-pocket medical expenses. Withdrawals for medical expenses are untaxed, and unused funds roll over year to year. An HSA must be tied to a high-deductible health plan--at least $1,000 a year for individuals or $2,000 for families--that kicks in for catastrophic coverage. Twenty percent of employers providing insurance now offer a consumer-driven plan, up from 5 percent just two years ago.
Critics maintain that consumer-driven plans are just the latest employer effort to push healthcare costs onto their employees and that the plans mostly benefit healthy, affluent workers. Advocates argue that if consumers have a bigger financial stake in their healthcare choices, they'll spend their healthcare dollars more prudently.
With the healthcare system in flux, consumers have more of a challenge than usual trying to pick a good plan this fall (nuts and bolts advice, Page 52). There are many ways to judge a plan, and the rankings on Pages 60 and 62 (and with more detail at www.usnews .com ) offer valuable information. But some areas where top-notch plans excel may not be obvious from a performance ranking or a benefits handbook. With consumers being handed more responsibility for managing their own care, not to mention picking up more of the tab, these indicators of quality care merit close attention.
Putting medical records online. Online access to medical records isn't essential--only about 15 to 25 percent of hospitals and doctors' offices have taken that step, according to a recent Rand study--but it has the potential to substantially improve patient care, reduce errors, and enhance patient communication and information. At Geisinger Health Clinic, all 750 staff physicians rely on electronic records, and the plan recently began allowing nonstaff doctors affiliated with the plan to view records online. When a doctor or nurse pulls up a patient's chart, in addition to the patient's medical history, the display shows any preventive tests or screenings that are due and, with a keystroke, lists all medications patients are currently on or have been on in the past and whether it's time for a refill.
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