Managed care vs. customer satisfaction
By Stephen W. Earnhart, MSPresident and CEO
Earnhart and Associates Dallas
Many of us are at an extreme point of frustration and dissatisfaction with managed care, HMOs, capitation, and the like. We keep getting crunched, mangled, and twisted in the unproductive paperwork, staffing cutbacks, and patient dissatisfaction associated with the various plans.
Unfortunately, we are becoming used to those hassles. But how do the end users, our patients, feel about these plans? We are clearly biased and, unfortunately, our opinions probably do not count for much in the greater scope of the issue. But I was curious and decided to do a bit of research into the topic. I came across a survey that had some pretty good information I want to share with you.
Report covers patients in three major cities
The Commonwealth Fund in New York City interviewed patients in Boston, New York City, and Washington, DC, and compiled the results into a report: Patients in Managed Care and Fee-for-Service Settings — Three-City Survey Finds Working Americans Dissatisfied. (See demographics, p. 28. Ordering information is in source box, also on p. 28.)I’ve taken the liberty of truncating some of the information as it applies to our industry. Below are excepts from that survey:
1. Managed care organization members report less satisfaction and lower quality of care than fee-for-service users.
Overall, managed care members are more likely to rate their plan as fair or poor (21%) than are fee-for-service users (14%). Fifteen percent of managed care members rate the quality of health care services they have received as fair or poor, compared with 6% of fee-for-service members. (See chart, "Patients Who Say Quality is Fair or Poor,’" p. 28.)
Managed care users are far more likely than fee-for-service users to rate their plans as fair or poor for access to services, including specialty care (23% vs. 8%), emergency care (12% vs. 5%), waiting time for a routine appointment (28% vs. 11%), and convenience of their provider’s location (17% vs. 4%).
Managed care members also are much less satisfied than fee-for-service enrollees with their plans’ ease of changing doctors (25% vs. 6%), choice of doctors (25% vs. 5%), and quality of doctors (17% vs. 4%).
2. Costs of care and paperwork requirements are a source of dissatisfaction for both managed care and fee-for-service enrollees.
Three in 10 members of both fee-for-service (31%) and managed care plans (30%) are dissatisfied with the premium they must pay for their plan.
Thirty percent of fee-for-service members and 25% of all managed care members are dissatisfied with their plan’s out-of-pocket costs. Twenty percent of fee-for-service enroll-ees and 16% of managed care members, are dissatisfied with their plans’ paperwork requirements.
3. Satisfaction with aspects of managed care depends upon the type of plan.
Thirty-nine percent of preferred provider organization (PPO) members have had major or minor problems with their plan not paying for services, compared with 25% of HMO members.
PPO members are more likely (34%) than HMO members (21%) to rate their plan’s reasonableness of out-of-pocket costs as fair or poor. PPO members (26%) are more likely than HMO members (16%) to rate their plan’s coverage of preventive services as fair or poor.
4. Reported health status does not differ for managed care and fee-for-service users.
Eighty-nine percent of managed care members and 91% of fee-for-service enrollees describe their own health as excellent or good. Eleven percent of managed care members and 9% of fee-for-service enrollees describe their own health as either fair or poor. Similar proportions of managed care (22%) and fee-for- service (24%) members report that they or a family member had a serious illness requiring extensive medical care within the last year.
Seventy percent of physicians practicing primarily in discounted and capitated provider payment plans report "very serious" or "somewhat serious" problems with limits on hospital lengths of stay; 57% report problems with limits on approval for hospital admissions.
More than eight in 10 physicians in managed care plans report "somewhat or very serious" problems with being able to refer patients to specialists of their choice. One in five physicians has left a managed care plan in the past three years. One in four who tried to join a health maintenance organization in the past three years has been denied entry.
Can the public’s perceptions be changed?
OK — now we have the feedback. The question facing us is, what can we do about it? Unfortunately, not too much. I think it’s important to know how the public feels about these issues and to be sympathetic.Short of trying to make their stay a little more personal, until the mindset of managed care becomes more user-friendly and compassionate, we are not going to see much change in perception of the general public.
(Editor’s note: For information on providers’ concerns about managed care and tips on surviving cost-cutting, see Same-Day Surgery, December 1997, p. 153.
Earnhart can be reached at Earnhart and Associates, 5905 Tree Shadow Place, Suite 1200, Dallas, TX 75252. E-mail: [email protected]. World Wide Web address: http://www.earnhart. com.)
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