HMOs Make Nice!

In an amazing full-paged advertisement appearing last week in many major U.S. newspapers, chief executives from 22 major HMOs proclaimed their intention to join with physicians in improving health care.  

The proclamation, coming from what the HMO executives are calling the Coalition for Affordable Quality Healthcare, pledged the member HMOs to spending the next 12 months making doctors' lives easier.  Among the promises made by CAQH are the standardization of physician credentialing, standardiazation of claims processing, and finding ways to reduce the denial of claims.

DrRich comments:

The Coalition for Affordable Quality Healthcare is a real organization. 

The fact that most of the major HMOs have felt compelled to form such a feel-good organization, and to spend all that money trying to convince doctors (the folks whose careers they've spent most of the past decade ruining) that what the HMOs really want is to find ways of helping them deliver quality care, is a sure sign that HMOs recognize they are are in deep trouble.  The HMOs are facing angry employers (since the increases in premiums to employers are again increasing at a rate of 10% per year), angry patients (who, for the first time, are leaving HMOs faster than they are joining them), and an angry Congress (which is still considering a Patients' Bill of Rights that is largely an anti-HMO document).   

We have documented for you the underlying operational philosophy of modern HMOs, and have shown you the life cycle of a fictional (though representative) HMO.  We have joined you in an HMO Death Watch.   And while we didn't forsee the Coalition for Affordable Quality Healthcare, such a move of desperation is completely understandable for an industry that is finally beginning to recognize that it's fundamental means of operation is not sustainable.  If, by making nice, the HMOs can hold off the hounds for another year or two, then making nice will be worth the effort to them.

One can hope so.  Cooperating with physicians might actually make HMOs somewhat kinder and gentler for a while, and might stay the hands of the Feds for a time.  If this latest effort delays the real HMO endgame for a few years (that is, the endgame where these same 22 chief executives say to the Feds, just like the railroad chief executives a few generations ago, "Here, we can't do this any more.  Give us a few billion for our trouble, and you can take over the whole mess,") DrRich, for one, is willing to tolerate the charade. 

08/05/2000

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