Disabled Getting Used to Cost-Cutting Managed Care System

Despite their initial qualms, people with disabilities can actually receive better medical care under managed care health plans than through the traditional doctor-patient setting, authorities said Friday.

However, patients must be informed and vocal about what they need, and physicians must regard the disabled as individuals with normal--as well as special--health-care needs, participants were told at a conference for the disabled and health-care professionals.

The conference at the Sutton Place Hotel in Newport Beach was sponsored by CalOPTIMA, which nearly two years ago began administering an HMO for all of Orange County’s Medi-Cal patients, including the disabled.

Many disabled people nationwide are concerned that they will not receive enough care and services under cost-cutting managed care systems, which pay doctors a flat rate per patient, instead of payments for each visit, speakers acknowledged.

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Disabled patients need more frequent and complex care, speakers said. They need to see specialists more and require expensive medical equipment, such as wheelchairs.

“And like it or not, we still live in a country that is uncomfortable with people with disabilities,” said Trish Riley, executive director of the National Academy for State Health Policy, based in Maine. “You’re working upstream.”

But managed care is the way of the future for the disabled and can provide better access to doctors, Riley told the 250-plus participants, many of them in wheelchairs or assisted by guide dogs.

“Managed care promises to think differently about how to provide care to people with disabilities,” she said.

A panel of consumers spoke of changes that have occurred since CalOPTIMA began.

When the disabled on Medi-Cal were told they were being assigned to a managed care system, “there was a collective cry of dismay,” said Charles Monson, who was paralyzed 18 years ago when he dived into a sandbar off Newport Beach. “The old system at least was a known quantity, although it certainly had problems.”

But Monson said he has received “better, more comprehensive care” under managed care.

Monson, who is a consultant for the disabled to other medical plans, said the system still has problems. He has heard from other disabled people about difficulties obtaining medical equipment quickly enough.

(Earlier this year, CalOPTIMA was sued by several disabled patients who alleged they were not receiving proper care under the program. CalOPTIMA and attorneys for the disabled are negotiating a settlement.)

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Linda Smith, who has adopted or gained guardianship of three disabled foster children, told the conference Friday that the family support group she directs was inundated with calls from people having problems when CalOPTIMA first started. But CalOPTIMA is responding to the problems and hiring liaisons to work specifically with the disabled, she said.

“It’s not a perfect system, but it’s a start,” she said.

Doctors, like the rest of the public, need to view people with disabilities as individuals first, said Brenda Premo, director of the California Department of Rehabilitation.

Legally blind, Premo was born with albinism and had to fight to attend regular school. A school psychologist gave her an IQ test, printed in small type, and because Premo scored low, she was told she was retarded.

“But all he did was test my ability to read small print,” said Premo, who holds a master’s degree from Pepperdine University.

Premo told of one case in which a woman paralyzed from the waist down began having spastic attacks for no apparent reason. It turned out the woman had not had a gynecological exam in years because her doctor did not have an exam table to accommodate her and, because of her condition, she felt no pain.

The woman had to go to a hospital for the exam, and doctors discovered she had a tumor pressing on nerves, Premo said.

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“Prevention is different when you talk about people with disabilities,” Premo said. Routine X-rays might be costly and unnecessary for the general population, “but if someone has a paralyzed bladder, an X-ray can prevent the need for dialysis” by revealing early stages of problems that the patient cannot feel, she said.

Besides, she said, a person with disabilities who is healthy is able to work, pay taxes and contribute to society.

Proper health care for the disabled, she said, “allows people to reach not only their physical potential but also their personal potential.”