Friday, February 20, 1998
Managing Care
HEALTH: Health plan aims to reduce medical fees while
providing
better, more efficient treatment for patients
By Kathryn Combs
Daily Bruin Staff
The controversy surrounding whether or not managed care is
helping or hurting California’s health care system is still
brewing.
Late last month, Gov. Pete Wilson unveiled his principles for
the reform of managed care in California. Wilson indicated that any
legislation should adhere to one very important principle: to
preserve or improve the quality of care without diminishing access
or harming the health of California’s economy.
Managed care is a health care plan designed to cut the cost of
medical services while improving patient outcomes.
Despite all the political flurry, medical center officials at
UCLA say that managed care has had both positive and negative
effects on the delivery of health care in the last 12 years.
"It does work," said Mary Frances Flynn, director of Managed
Care Business Development.
"It is a different system for people to learn, and as a patient
there are many more perceived challenges in terms of receiving
care," Flynn said.
Nearly 85 percent of Californians currently receive medical
attention under managed care programs. However, just over 75
percent express satisfaction with these services, according to the
Office of the Governor.
"From the perception of the patient, managed care doesn’t give
them the freedom of choice that they have had in the past," said
Dr. Michael Karpf, vice provost for hospital services at UCLA.
"It is not quite as open as the health care system used to be,"
he added. Karpf was a member of the task force that contributed to
Wilson’s proposals.
According to Gerald Levey, provost of the UCLA School of
Medicine, managed care has a positive impact on the university.
"Managed care has done some very good things for UCLA," said
Levey.
"It has forced us to look at all aspects of our operations and
essentially made us a far more efficient hospital," Levey said.
"It has enabled us to do things that five years ago would have
been unimaginable," he added.
Managed care has allowed the university to extend services
outward to the surrounding community, Levey said.
As a result, UCLA has built clinics in the surrounding community
and acquired the Santa Monica hospital in 1995 as part of the UCLA
health care network.
"(Managed care has) essentially required us to add an additional
hospital for primary care, and therefore led to our acquisition of
the Santa Monica hospital," Levey said.
These changes have removed the perception that UCLA is an
isolated institution.
"All of these developments, which have stemmed from a managed
care environment, have been very positive for UCLA. It has given
UCLA a community presence which we never had before," Levey
said.
According to UCLA officials, managed care, while not flawless,
has created a greater level of awareness regarding what hospitals
need to do to cut cost and maintain quality care.
"There is now a greater level of awareness of managed care and
how medicine can benefit from it. (However) it is not without its
problems and it certainly represents a change that is difficult to
make," Flynn said.
Opponents complained that managed care programs are inaccessible
to all patients and that the quality of care is dwindling, placing
cost over care.
"On the negative side I worry, as many do, whether managed care
will remove the ability of patients to have mobility in the
system," Levey said.
"I also have concerns that individuals will not have access to
the latest medical advances, which are often very costly," Levey
said.
"Everyone should have access to the latest developments in
medical technology, diagnosis and therapeutics," he continued.
Institutions like UCLA are beginning to measure how well managed
care is working.
"We are expanding the number of managed care contracts we have,
and have been increasing the number of members we see in both the
Westwood and Santa Monica hospitals," Flynn said.
"We are expanding the number of contracts we have," she added,
"so that we can make this available to more people, so that
everyone will have the opportunity and choice to have UCLA as their
provider."
"Managed care … makes it easier to measure the quality of
care, although quality and outcome measurement is in its early
stages of development," Flynn said.
"By critically analyzing what we are doing, we can do it well
and efficiently," Karpf said.
According to Karpf, managed care programs allow doctors and
administrators to measure the outcomes of patient care more than
the previous fee for service system.
"(Managed care) is a system that needs to be implemented and
better understood," said Josie Rice, administrator with UCLA
Managed Care programs.
"It’s not a bad system. However, it’s like any other program. It
just needs time to develop," she added.
"Managed care is not disappearing," Karpf said. "It will be made
a little bit more flexible, but fundamentally it is not going
away."