ROANOKE TIMES
Copyright (c) 1997, Roanoke Times
DATE: Tuesday, March 25, 1997 TAG: 9703250109
SECTION: NATIONAL/INTERNATIONAL PAGE: A-1 EDITION: METRO
DATELINE: NEW YORK
SOURCE: STEVE SAKSON ASSOCIATED PRESS
Oxford will unveil the program today as part of an overhaul designed to address the most frequent gripes about managed care and save the company money.
One of the nation's leading HMOs will allow members who have an operation to rate the hospital, surgeons and nurses in a report card that will be given to other patients facing the same surgery.
The program by Oxford Health Plans Inc. is designed to improve the performance of surgical teams and let new patients choose teams that have the most experience, highest success rates and best bedside manner.
Oxford will unveil the program today as part of an overhaul designed to address the most frequent gripes about managed care and save the company money.
Another sore spot Oxford will target: the frustrating process of getting claims or medical information from anonymous HMO clerks on the phone.
Each Oxford member will get a ``personal service agent'' - one person to call whenever they have a question. The agent will be responsible for getting the caller an answer within 24 hours.
Enrico Madonna, an Oxford member from the New York City borough of Queens, got such service as part of a pilot program last year and said the agent was invaluable in answering questions about his wife's pregnancy.
``When you're dealing with one person, they know your situation without you having to re-explain it every time you call up,'' he said.
Health economists, often skeptical of HMO motives, applauded Oxford's moves.
``This obviously will take some effort to get it right, but to move that way is really quite impressive,'' said Uwe Reinhardt, a health care economist at Princeton University.
Oxford, based in Norwalk, Conn., serves about 1.7 million members, mostly in the Northeast. It is one of the most profitable health maintenance organizations at a time when many of its competitors are struggling with rising medical costs.
The company has moved aggressively into ``point of service'' plans, which let members choose doctors and hospitals outside the closed HMO network if they agree to pay part of the cost.
Last year, it began covering alternative medicine such as acupuncture, massage, yoga and herbal remedies.
While other HMOs are trying to boost their profit margins by restricting drug choices and imposing tighter controls on doctors, Oxford says it hopes to save money and improve care, too.
Its new surgery program abandons the current, sometimes haphazard, system of arranging an operation. The company is asking surgeons to set up teams of medical professionals to provide a specific service at a preset fee.
Examples include delivering a baby, performing a heart bypass or a hip replacement. Typical team members would include a hospital, other surgeons, anesthesiologists, physical therapists and visiting nurses. Oxford has set up more than 200 teams and hopes to establish 500 more this year.
Patients will pick their team after reading the report cards on several.
``We're giving people more power to make their own decisions in health care and we're giving them the tools to make those decisions,'' Oxford chairman and chief executive Stephen Wiggins said Monday.
For instance, a man considering whether to have a cancerous prostate gland removed will find out what percentage of a surgeon's patients suffered incontinence or impotence after similar surgery.
The program will be optional, but Wiggins hopes patients will prefer it.
``Most people have no idea about the training, background and success rate of providers before they undergo surgery,'' he said. ``Our game plan is to clear the clouds, because sunshine is the best disinfectant.''
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