When 95 health plans announced last month they would have to pull out of the managed care Medicare marketplace, the ceremonial finger-pointing at the Balanced Budget Act and federal government did little to assuage the confusion and disappointment of 327,000 seniors who are affected by the exits.
It has, however, forced seniors to become much more involved in the business of managed Medicare and the politics of federal reimbursement. This is an intentional result of the defense-mode communication tactics used by an industry regularly accused of caring more about the bottom line than high-quality care.
Humana, for instance, immediately blamed "government reimbursement inadequacies" for its decision to withdraw its Humana Gold Plus Medicare HMO from 31 of the 89 counties in which it offers a Medicare product, affecting 46,000 of its 480,000 beneficiaries. And PacifiCare Health Systems, which offers the country's largest Medicare HMO, Secure Horizons, attributed its exit from 12 counties in Ohio, Washington, Oregon and California, to the "widening gap between rising healthcare costs and the amount the federal government pays Medicare HMOs." Its exits will affect 16,400 members.
The government isn't buying it. Its position is that many of the plans leaving the Medicare program were scheduled to receive increases of as much as 10 percent.
It remains to be seen whether this back-and-forth wrangling is causing further deterioration to an already suffering managed care image. Plans that use consistent issue-focused communication with its members will be the ones that have the best chance of emerging from these pullouts with their image intact.
Best of a Bad Situation
These massive exits mark the second time health plans have had to pull out of Medicare. Last year, withdrawals affected 407,000 members from 45 plans. Communication about these exits requires sensitive, proactive, multi-departmental and logistical prowess, says Ben Singer, PacifiCare's VP of PR. PacifiCare started laying the groundwork for its exits a year ago with frequent town hall meetings and communication in its member publications.
The meetings, which attracted 300 to 1,000 members, have been the most effective at discussing tough issues like Medicare inflation, HMO profit motives and quality of care issues, says Singer.
Senior management from provider relations, government relations, marketing and the clinical department are charged with the task of explaining Pacificare's position at these meetings, which often become emotionally charged.
For seniors, the healthcare stakes are high. In some markets seniors will be able to choose an alternative HMO; in others the only option they will have is traditional fee-for-service Medicare. To add to this frustration, Medicare HMOs are expected to announce price increases this fall.
The government requires that health plans communicate these changes via direct mail to seniors but that process is fraught with confusion. The first wave occurred in June when health plans had to tell beneficiaries they were pulling out and provide information on other health plans (if any) that were available in the market. "We could only say what [HCFA] approved and the messages had to rely on a lot of disclaimers," says Eileen Hutchison, Humana's senior director of marketing communications.
In some instances the media has added to an already chaotic situation by misreporting the markets that were affected by HMO exits and harshly characterizing the pullouts as seniors being "abandoned," "axed" and "dropped."
"There's a lot of noise out there with the media trying to find an interesting hook to report on. It's our job to make seniors aware of what all the managed care changes mean," says Singer. PacifiCare, which regularly measures how effective its communications are with seniors, has made important strides in this area with 75 percent reporting they felt better informed about managed Medicare issues.
(PacifiCare Health Systems, Ben Singer, 714/825-5120; Humana, Eileen Hutchinson, 502/580-1140; HCFA, Peter Ashkinaz, 202/690-5649)