Roanoke Times
Copyright (c) 1995, Landmark Communications, Inc.
DATE: SUNDAY, August 27, 1995 TAG: 9508250046
SECTION: BUSINESS PAGE: F1 EDITION: METRO
SOURCE: SANDRA BROWN KELLY
DATELINE: LENGTH: Medium
Circumstances in the health care demand that we all wake up to the new world order. Most employees are in some type of health care program that controls their access to physicians and hospitals. Also, citizens covered by Medicaid, the health care program for indigent persons, are being moved into managed plans, and senior citizens are being encouraged to think about such plans as an alternative to Medicare.
Most everyone's care is being managed is some way, and it can only get more confusing.
For this reason, an upcoming Public Broadcasting System special might be just what the doctor ordered to help everyone in the health care food chain think smarter.
"Your Money & Your Life: America's Managed Care Revolution," will be aired Sept. 6 at 10 p.m., but a Worldwide Web page has already been established on the Internet where computer users can learn about the show, get the background of panelists and even read a transcript of what is to be broadcast.
The 16 panelists range from consumer advocates Byllye Y. Avery, founder and past president of the National Black Women's Health Project, and Ellen Goodman, syndicated columnist, to executives from an insurance company, a managed care company and the top official of Columbia/HCA Healthcare Corp., the nation's largest hospital system and one that owns several facilities in Western Virginia.
Columbia owns Lewis-Gale Hospital and Lewis-Gale Psychiatric Center in Salem, Montgomery Regional Hospital in Blacksburg, Pulaski Community Hospital in Pulaski, Alleghany Regional Hospital in Low Moor and Clinch Valley Medical Center in Richlands. If for no other reason, area residents might want to tune in to hear Rick Scott, Columbia chief executive officer and chairman.
However, the show promises even more.
Managed care, as defined on "Your Money & Your Life," is "a broad and constantly changing array of health plans that attempt to control the cost and quality of care by coordinating medical and other health-related services."
Simply put, it's complex.
To employers, managed care is an opportunity to lower costs of insurance plans for employees.
To doctors, it means they no longer can practice medicine by their own rules. Insurers set many of the standards, such as what medical procedure is acceptable in a certain illness or how long a patient can remain in the hospital. Also, doctors not only are under pressure to keep people well or to heal them, they also have to keep their own costs down so that they will be acceptable to join managed care networks.
Hospitals, likewise, must know their expenses right down to the staple that holds an incision together in order to negotiate a living wage from insurance companies, and be acceptable to networks.
What we hope everyone in these groups is ultimately concerned about, however, is what managed care means where it counts - when we or a family member get sick.
But policyholders often don't know what their insurance covers.
If you have a child on your policy who has asthma or diabetes, do you know if it pays for treatments? Women, do your policies cover mammograms?
Around November each year, most workers participate in the annual ritual of deciding on a health care plan for the next year. It's an anxiety-producing experience, but might be less so after you meet "Mary" on this show.
"Mary" is Mary Harris, a pregnant woman who is concerned about her employer's change-over to managed care. She is the star of the scenario panelists and viewers will be presented.
Mary wants to see the obstetrician who delivered her previous baby, but, guess what: He's not in the Health Maintenance Organization that her company has chosen. Mary's boss, played by former Secretary of Health, Education and Welfare Joseph A. Califano Jr., says she can remain in the previous health plan if she pays an additional $150 per month.
So Mary has to ask some hard questions. The hope is that those questions, and the panelists' responses, will demystify managed care.
Among the questions the show promises to get at is: Are physicians able to advocate for their patients' medical needs in an increasingly cost-conscious health system?
The PBS show was produced with funding from the Robert Wood Johnson Foundation, the nation's largest health care philanthropy. Host is Tim Russert, who is also host of "Meet the Press," and moderator is Arthur R. Miller of the Harvard Law School.
The hope is that it will kick off discussions on managed care, either within a community or on the Internet. The Web page address is http://www.wnet.org or http://www.pbs.org.
If Mary inspires you to want to discuss more about the issue, contact health and medical writer Kelly at The Roanoke Times, 981-3393, or at her electronic mail address, sandrakinfi.net.
by CNB