NATIONAL REPORTS—The San Francisco health access plan raises challenges for MCOs, say industry experts.
"California is a bellwether for the country," says Michael Gorton, founder, chairman and CEO, TelaDoc Medical Services Inc.,
a telephone medical consult company in Dallas. "Managed care executives are certainly following this ... to assess their
opportunities for capturing increased market share."
Last month, the San Francisco Board of Supervisors gave initial approval to a plan that would give access to the city's uninsured.
Employers would contribute funds through a mandate proposed by Supervisor Tom Ammiano. At presstime, it seemed likely that
the plan would pass the required second board vote and be signed into law by San Francisco Mayor Gavin Newsom.
As leaders throughout the country evaluate and assess the options for tackling these issues, managed care decision makers
will need to decide how best to capitalize upon the opportunities. "It will be incumbent upon companies to be poised to work
with government, as well as private sectors in the delivery of decision-making tools, products and services that will make
plans, like the San Francisco model, become operationally successful," according to Chini Krishnan, founder and CEO of Healthia
Inc., an integrated comparison-shopping portal for healthcare products and services, headquartered in Mountain View, Calif.
"Administering any kind of health plan is an unbelievably complex task," Krishnan notes. "The question really becomes: Can
a city government deliver the kinds of customer service that a private professional organization can, as cost effectively
as a professional organization can?" Krishnan asks.
GOOD IMPLEMENTATION IS KEY
Krishnan and others point out that the opportunity for universal coverage is sound only if there is well-constructed implementation.
"The proposed program is one public policy approach to the larger question of how we as a society should deal with rising
healthcare costs and increasingly complex payment mechanisms," says Robert S. Oscar, RPh, president, RxEOB, a provider of
consumer-centric pharmacy benefit software. "This particular program is consistent with America's heritage of linking healthcare
benefits with employment. A limitation to the San Francisco solution may be that it is constrained geographically. Many would
prefer to see a more universal solution or program."
Public and private entities must address the problems around efficiency and cost, and look to solutions that offer speed
of access to medical care and affordability, Gorton adds. "It is imperative that we off-load the burdens on hospital emergency
rooms and truly meet the needs of healthcare consumers," he says.
In addition, says Gorton, healthcare consumerism and the retailization of healthcare must be factored into any solution. "If
governments adopt universal care, they must also be prepared to provide a full breadth of opportunities for patients to be
empowered consumers," he says.
