Putting the ‘Care’ Into Managed Care, Before Reformers Do

Amid sweeping changes in Medicare laws and critics’ calls for tighter regulation of managed care, industry behemoth PacifiCare Health Systems Inc. is attempting to cast itself as the consumer’s friend.

Last week in a Torrance hotel, Alan Hoops, the Santa Ana company’s chief executive, stood before a hotel gathering of about 1,000 members of its Medicare plan and fielded questions.

He’d heard their major concerns many times before--questions about why PacifiCare’s Secure Horizons plan for seniors on Medicare doesn’t cover certain drugs or services, or how members can register complaints about their health care.

As simple as it sounds, what mattered to Hoops was that he and key PacifiCare employees and so many of the company’s customers were together in the same room. “We sit up here and they become real, and they sit out there and we become real,� he said after the session.

PacifiCare, the nation’s largest provider of Medicare managed care, and one of the largest health maintenance companies generally, has launched a campaign to reach out to consumers.

In January, the company began a program to call all of its 600,000 Secure Horizon members in California to see whether they’re satisfied with the plan and to solicit opinions on how problems can be fixed. About 100,000 members have been contacted so far, and the staff hopes to get to the rest by the end of next year.

After listening to members’ concerns, PacifiCare halved the flat charges seniors pay for drugs. Payments on generic drugs dropped to $5 from $10, and branded drug charges fell to $10 from $20.

In June, the company began making counselors available to visit members’ homes, if necessary, to talk over plan issues.

Last week, the company also said it plans to make public its ratings on the quality of care that its medical groups provide.

The meeting with Secure Horizons members last week was the first of five scheduled this month throughout Southern California.

The atmosphere was friendly, if not upbeat, as senior citizens gathered in the air-conditioned hall at the Torrance Marriott Hotel on a scorching-hot day. The company had promised added incentives: free refreshments, prizes and parking.

Some stood up and politely asked questions, and Hoops and staff answered them. Others submitted questions on cards that staff summarized for the crowd and addressed.

Staffers made public promises to address individual beefs and passed out their business cards.

Wydell Wesley Hughes, a retired actor, on crutches, asked why the plan wouldn’t cover support stockings for circulatory problems in his legs. A PacifiCare employee examined a request letter from Hughes’ doctor and declared him eligible.

“Great!� Hughes responded.

Making sure Hughes, and many other members like him, are happy is key to PacifiCare’s strategy to expand amid vast changes afoot in health care regulation.

As Hoops told his customers last week, Medicare has cut back the rate of increases being allowed in reimbursements for managed care plans--a move that could cause plans to trim their offerings to members.

Indeed, PacifiCare itself just eliminated a special plan allowing seniors to pay a monthly $49 premium for access to doctors outside its network. Under the plan, a patient could see any doctor for a flat $25 charge. Though the company started it last year to meet customer requests for flexibility, it canceled it in August after only about 1,500 people signed up in Southern California.

Consumer advocates see PacifiCare’s community outreach as an attempt both to position itself for growth in Medicare and to offset critics’ demands for laws making sure that HMOs give patients access to appropriate medical care.

Recent changes in Medicare laws, intended to encourage people to move into managed care plans, create both opportunity and potential competition for PacifiCare.

Experts said PacifiCare also may be reaching out to blunt calls by advocacy groups nationally to make it easier for patients to sue their HMOs over medical care problems.

“A lot of folks feel that HMOs are making medical decisions . . . and that plans don’t have the proper incentive to provide adequate care because they aren’t legally responsible,� said Betsy Imholz, a Consumers Union lawyer.

If responses from seniors who attended the meeting in Torrance are any indication, PacifiCare’s effort is bolstering its image.

Nearly a third of the 345 attendees who responded to a questionnaire about the session indicated they left with a “much better� perception of PacifiCare. Another 30% checked “somewhat better,� 23% said “no change,� 14% didn’t answer, and 1% checked “worse than before.�