Colorado consumers restricted to sub-networks of providers
Back Page Briefs
November 30, 1997
2 minutes read
MINNEAPOLIS, MN—Colorado consumers may not have as many provider choices as they think when they enroll in a managed care plan and get a thick provider directory, reports Minneapolis-based consultant Allan Baumgarten in his recently released 1997 Managed Care Review for Colorado. These provider directories consist of a series of subnetworks, sometimes referred to as physician pods, which essentially limit enrollees to receiving all their care through that sub-network. Enrollees cannot go to physicians outside these pods without changing primary care doctors.
After consumers brought concerns over these restrictions to the Division of Insurance, the Legislature passed a bill requiring additional disclosure by the plans of how such arrangements work.
While such pods create opportunities for provider networks to integrate more effectively and for purchasers and plans to hold providers more accountable, Mr. Baumgarten writes, it remains to be seen whether such arrangements ultimately restrict or promote choice. "In some ways, it keeps coming back to the availability of information that would enable consumers to actually make reasoned choices," Mr. Baumgarten writes. "Whether the choice is a physician pod within an HMO or choosing among several HMOs, each offering thousands of physicians, the choice becomes meaningful only if consumers have tools and information."Contact Mr. Baumgarten at 612-925-9121.
FAACCT develops tool for organizing health plan data
PORTLAND, OR—The Foundation for Accountability (FAACCT) has decided that what the world needs is not more data but a better way to organize that data so that consumers and even purchasers can develop a better understanding of health plans. The framework, which organizes and sorts data, is expected to be used by the U.S. Health Care Administration for evaluating Medicare plans and by state agencies, as well as by large associations such as the National Alliance for the Mentally Ill and the American Association of Retired Persons.
The FAACCT framework sorts data into five broad categories: The Basics, access, skill, communication, coordination of care and follow-up; Staying Healthy, helping people maintain their health; Getting Better, helping people heal; Living with Illness, helping the chronically ill and Changing Needs: helping people when their health changes dramatically.
Colorado consumers restricted to sub-networks of providers
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