Image Therapy : HMOs have taken a public-relations drubbing from the news media in the last year.

When Kaiser Permanente Chairman David M. Lawrence wrote a letter to union boss John J. Sweeney last month, he prevailed upon the AFL-CIO president to get labor to stop trashing the giant health plan.

Although the Feb. 16 letter discussed ways Oakland-based Kaiser and its unions could work more closely and with less confrontation, Lawrence made it clear he wanted something in return.

“If proprietary information is leaked to the media, or anti-Kaiser consumer advocates,” Lawrence warned, “we will discontinue sharing and return to square one in our partnership efforts.”

Lawrence also said the AFL-CIO--whose affiliates represent 53,000 Kaiser employees--must cease criticism of a hospital reorganization plan in California, withdraw support of “anti-Kaiser” legislation and refrain from “attacking our quality [nonprofit] tax status or integrity. . . .”

It apparently wasn’t the right thing to say. Sweeney will fly in from Washington to make a whirlwind tour of California on Tuesday, meeting with local union officials to promote a stepped-up pressure campaign against Kaiser.

But it’s no wonder Lawrence is frustrated. His company, which pioneered the managed-care industry 50 years ago, and other HMOs have taken a public-relations drubbing from the news media, consumers, doctors and labor unions in the last year.

So the industry is mounting a counteroffensive, using folksy advertising campaigns, high-profile Washington lobbyists and marketing pitches, including one where Kaiser levels some of the same criticisms at its competitors that the industry objects to hearing from outsiders.

“There is an antimanaged-care hysteria out there, and some stories based on single anecdotes have gotten blown out of proportion,” says Daniel Danzig, Kaiser’s chief spokesman.

The managed-care industry has been attacked on numerous grounds, including quality-of-care issues, maternity discharge policies and physician “gag orders.” The publicity has helped spawn a host of HMO jokes and unflattering references on hit TV shows such as “ER.”

In January, the cover of Time magazine had a doctor with his mouth gagged, illustrating the controversial requirement by some HMOs that doctors agree not to criticize them. The same month, U.S. News & World Report reported on “How Your HMO Could Hurt You.”

Managed care has been investigated by major newspapers, including the Los Angeles Times last August, and major TV news programs such as “60 Minutes.” Blared a huge front-page headline next to an infant’s photo in the tabloid New York Post: “What His Parents Didn’t Know About HMOs May Have . . . KILLED THIS BABY.”

Media scrutiny of managed care is “probably appropriate,” Danzig says. “But we just hope that coverage will also be fair, and that some of the benefits of managed care will be reported more completely.”

HMO officials complain that the coverage is largely one-sided, concentrating on anecdotal “horror stories.” They note that some major surveys have found that in certain areas such as preventive care or consumer satisfaction, HMOs have scored as well as, or better than, traditional fee-for-service health plans.

“Our plans pioneered a style of health care and have made great progress in promoting better care at lower cost,” HMO executive George Halvorson told industry leaders at a trade group meeting last month in Washington.

Halvorson, president of the American Assn. of Health Plans, whose members cover about 100 million Americans, also lashed out at the news media and industry critics. Managed care, he asserted, is facing “attack by anecdote” from “enemies . . . that will try to use the only arguments left: . . . out of context, extremely emotional, negative anecdotes.”

The unfavorable publicity doesn’t seem to be hurting industry membership growth--at least not yet--but HMO officials aren’t taking any chances.

The AAHP is mounting its own national public-relations campaign with the message that the managed-care revolution is good medicine for America.

Meantime, six of the nation’s biggest publicly traded HMOs have embarked on a separate image-building effort. The plans, which include California-based FHP/TakeCare, Health Net and PacifiCare Health Systems, are paying more than $700,000 to a high-powered Washington public relations and lobbying firm to burnish the industry’s image in a campaign that will begin in April, according to one HMO official.

The firm, run by former White House press secretaries Jody Powell and Sheila Tate, represented pharmaceutical companies during the 1993 debate over President Clinton’s scuttled health-reform proposals.

Don Prial, a spokesman for Woodland Hills-based Health Net, said the campaign is ultimately aimed at politicians. In Washington and in state capitals nationwide, a flurry of legislation aimed at regulating managed care has been enacted or is pending.

“If we can get the message about managed care out to the general public, then we’ll have a better-informed population, which will inevitably lead to a better-informed Congress and legislatures,” Prial said. “This industry has not done a good job of telling its story.”

Its rebuttals have already begun.

In January, Health Net officials were irate after The Times and Time magazine ran articles about a legal case involving the health plan’s refusal to pay for a potentially life-saving bone-marrow transplant for a breast cancer patient who later died. Health Net denied the procedure on the grounds it was experimental and not covered under the patient’s policy.

The HMO, with 1.4 million members in California, responded with full-page ads in the state’s major newspapers. Carrying the headline “A Frank Discussion About Health Care and Transplants,” the ad sought to tell the company’s story by explaining its policies governing organ transplants.

Health Net says it will run more ads this year on such issues as AIDS, maternity care and physician compensation,

PacifiCare, an Orange County-based HMO, just launched a newspaper ad campaign to “tell the equally dramatic success stories that we’ve refrained from telling,” company spokesman Ben Singer said.

The promotion by PacifiCare, which operates the nation’s largest HMO for Medicare recipients, will feature residents of Glennville, a small, “Mayberry-like” town near Bakersfield, Singer said.

Nearly all of the town’s 28 Medicare-eligible residents belong to the PacifiCare Secure Horizons plan, he said, and the ads will show those members “stepping forward and talking about their experiences.”

“Everyone,” Singer said, “is looking to find the happy member or get the happy doctor to tell how well [managed care] works.”

Meanwhile, what’s unfair criticism to some is advertising fodder to others. That’s the case with Kaiser, the nation’s largest HMO, which launched a TV and newspaper ad campaign that began last November.

Kaiser, a nonprofit firm, has long strived to differentiate itself from other health plans. In California, Kaiser operates a tightly controlled “group model” HMO; it owns its own hospitals and uses doctors who work exclusively for Kaiser. Most HMOs contract with a variety of hospitals and doctors who may work for many insurers.

In newspaper ads carrying the headline “A Health Plan So Unique, You Feel Good Just Thinking About It,” Kaiser’s ads call attention to controversial practices in the industry--some of the same issues that HMO critics often target.

Kaiser members, the ads proclaim, “get a specialist without the delay of a committee review,” and “we don’t have insurance administrators telling your specialist how to treat you.”

In the last year, Kaiser has faced a flood of critical coverage over such issues as maternity discharge policies and its policy of requiring members to settle disputes with the plan through binding arbitration rather than the court system. Several stories have been prompted by disclosures of confidential company documents that have been leaked to reporters by labor unions or consumer groups.

As for the warning from Kaiser’s Lawrence to quit criticizing his company--in a letter obtained by The Times from consumer activists--the AFL-CIO’s Peter diCicco, secretary-treasurer for industrial unions, said, “Lawrence has put such terms and conditions on this that it makes it impossible for us to agree.”