|
The
ABCs of HMOs 12/11/04
These days if you're an HMO you need broad shoulders and a
sense of humor. With large for-profit health plans dominating
other parts of the country, they've unfortunately developed
a reputation for being more profit-minded than member-minded.
However,
in Michigan the dominant heath maintenance organization is
Blue Care Network, a nonprofit organization and a subsidiary
of Blue
Cross Blue Shield of Michigan.
"We're
not accountable to stockholders. Our board isn't out to squeeze
profits for investors. In fact, our board of directors includes
plan members elected by our members, doctors and group decision-makers,"
said Kevin Klobucar, vice president and regional executive
for Blue Care Network.
HMOs
do provide health coverage in ways that are different from
other plans. Understanding these differences can determine
how satisfied a new member is with the plan.
Everyone
picks a primary care physician
When members join Blue Care Network they select a primary
care physician from a list of doctors who contract with the
plan. The BCN network includes more than 3,300 family doctors,
internists and pediatricians. The member's PCP provides much
of the care needed for the member, but also helps guide the
member through the what can be a daunting maze of health care.
If the member needs to see a specialist, the PCP will provide
a referral. Services that the member obtains on his or her
own are not likely to be covered.
The
emphasis is on prevention
All BCN coverage includes immunizations, physicals and important
screens (co-payments may apply). Members are encouraged to
use these benefits to head off illnesses or catch them early.
The
plan encourages better health choices
HMO members receive lots of information to help them maximize
their health. BCN, for instance, provides members with a catalog
of classes and community resources, many offered at a discount.
The plan has programs for members with asthma, diabetes, congestive
heart failure, migraines, low back pain and other chronic
conditions. It's the only health plan in Michigan to offer
Accordant Care, a program for patients with any of 14 rare,
complex medical conditions. Members enrolled in any of these
disease management programs receive newsletters specific to
their condition, reminders and even phone calls so they can
better control their conditions.
"Under
our BlueHealthConnection program, we have a huge array of
programs to help members stay healthy, get better if they're
sick and live well even if they have a chronic condition,"
said Klobucar. "We really see it as a three-way partnership
- between the health plan, the primary care physician and
the member."
|
