Well-designed implementation key for San Francisco access plan

August 1, 2006

NATIONAL REPORTS-The San Francisco health access plan raises challenges for MCOs, say industry experts.

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.

"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.