Cherrypicking 200I - Internists are not PCPs

We have noted elsewhere that HMOs have been having more and more trouble cherrypicking (selecting healthy patients for enrollment, while discouraging elderly or ill patients from enrolling) lately.  Now an HMO, Care Choices in Muskegon, Michigan, has come up with a completely novel approach that will warm the cockles of many an HMO executive's liver (they having no hearts.)

The new approach (like all truly great ideas) is elegant in its simplicity.  Care Choices has simply declared that internists in their HMO network are no longer PCPs (primary care physicians).  All patients who are using internists as their PCPs have been directed to choose a general practitioner or a family practitioner to become their PCP.  PCPs are necessary because, without a referral from a PCP, patients will not be able to see specialists - like their internists - any more.

The true beauty of this new ploy is two-fold.  First, patients who have chosen internists to be their PCPs are statistically far more likely to have serious chronic illnesses.  They are the very patients HMOs attempt to avoid or shed. So Care Choice, in making this directive, has gained an immediate fiscal advantage.  Apparently it has pushed over 700 of its enrollees (many with expensive illnesses) into limbo - unable to see their internists, or any other doctors, until they find a new PCP.  Second, none of the doctors sanctioned as honest-to-goodness PCPs by Care Choice (the GPs and the FPs) are accepting new patients, as their practices are full.  So from the looks of it, these relatively elderly and ill patients will be left in the cold for a while - ideally, one suspects Care Choice must be thinking, until they can get another insurance carrier.

Care Choice claims to be making every effort to convince GPs and FPs who have closed their practices to accept some of these newly disenfranchised patients.  But it's got to be a hard sell - and HMOs must know that, having spent the past decade giving PCPs powerful incentives to avoid the sick.  The last thing PCPs want in their practices these days are sick people, who will drive up their average expeditures, thus driving down their "quality" rating, and ultimately decimating their pay schedule.

It's not your father's cherrypicking.  The HMOs may be down, but they're certainly not out. 

February, 2001

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