Lesson for HMOs: Time With Patients Is Profitable
Last month, Harvard researchers found that 51% of Americans believed that managed care was eroding the quality of health care in America. Now, in a new UC Berkeley study, Californians express even more pointed criticism: 42% of those surveyed reported having problems with their health plans in the last year, ranging from denials of medical care to delays in treatment to difficulty getting referrals to specialists.
But not all the news is bad for HMOs, for the survey also points out what’s working.
For instance, despite the large number of respondents reporting problems, 76% also reported feeling “satisfied” or “very satisfied” with their health plan.
A close reading of the survey shows that what has come to trouble many HMO patients is not so much poor-quality care but the kind of overly rushed care that some HMOs provide. In last month’s Harvard survey, people seemed most concerned over their increasingly short examining room sessions with doctors; 61% of respondents said the time doctors spend with patients had decreased.
Managed care companies should learn from both studies that there is no surer way of building patient satisfaction than to allow doctors to spend adequate time with their patients. The UC Berkeley study, for instance, found that the highest patient approval ratings went to “group/staff” HMOs--managed care companies like the Kaiser Foundation Health Plan that give their physicians and nurses more time to spend with patients for counseling and preventive care. That conclusion was bolstered by a study released last week showing that among Medicare HMOs, Kaiser had the lowest patient turnover. The benefits in customer loyalty and in improved long-term health care outcomes more than compensate for slightly higher costs for physicians’ time.
The Berkeley study was commissioned by a state managed health care task force appointed by Gov. Pete Wilson and led by Alain Enthoven, a Stanford health economist who helped pioneer managed care. Enthoven dismissed some survey respondents, saying they were just grousing about the relative lack of luxury in HMOs. Fair enough, but at least one of the Berkeley findings cannot be dismissed so lightly: 21% of those surveyed not only reported some type of problem with their health plan, they said the problem had worsened their medical condition.
Enthoven’s task force, which is now drafting proposed reforms aimed at improving California’s HMO oversight, must not shirk this problem. Its proposed oversight body certainly should have enough political independence and regulatory clout to oversee HMOs more diligently than the state’s current regulatory body, the Department of Corporations.
Government oversight is crucial. But so too is the HMOs’ responsiveness. The surveys clearly show that patients want counseling and advice from their doctors and nurses, not just medical procedures. Low patient turnover is a cost saving, so a little more time spent “just talking” can actually have a bottom-line payoff.
