Managed Health Care Advice

Even though it seems as if managed care has been around for quite awhile (or is it that it gets so much media attention that it's in front of our faces every day?), the truth is every single state is experiencing its' own rate of growth with regard to the active players in this game.

For the new graduate, deciding where to practice, as it relates to what plans are currently open to new providers, can be especially tricky. The term, "closed panel" is often bantered about, but this does not mean that provider should throw up their hands and walk away! A closed panel usually means that that provider has accepted all of the practitioners for that speciality that they care to. This does not mean that there is no possible chance for your participation, however.

One possible tact, for both the established and the new graduate, is to contact the manage care entity(s) you would like to contract with and find out who their current panel of providers is. Once you have done that, it is suggested that you find within yourself and your practice, something that differentiates you from them. Is it technique? Diplomat status? Involvement in a multi-disciplinary practice? The key is to find something that makes you unique and would fill a niche that the plan may not know they have open.

Then contact the plan manager and explain why you, or your practice, would serve their plan members so well. Why you would be an asset to their "team" and why you would very much appreciate receiving an application and contract. Does this work all the time? Definitely not. It does, however, keep you from feeling helpless and hopeless.

But there is another problem inherent in this managed care game. How do you know who the players are? This is a much harder question to answer. All HMO's and some PPO's have to register with the insurance department of the state in which they are operating. So it is possible to contact this department for a list of these plans.

What about IPA's and other individualistic entities. This is a tougher problem to address. Because they are not required to register with the state, tracking their existence can be problematic. Contacting the chiropractic state association is one alternative, but another, possibly more useful route, is to contact providers within the geographic region you are in or wish to practice in. Not only can they give you valuable information as to the names and addresses of existing plans, often times they can give you insights into their experiences with these plans.

Finally, don't disregard the internet and the world wide web as a source. One site in particular, (http://www.medicaldata.com), gives the "HMO penetration rate profile." This is a detailed map showing not only the percentage of penetration of HMO's within a state, but who the HMO entities are. They describe the penetration rate as "the percentage of population covered by a licensed HMO." This is one more key to this puzzle and you may find this quite useful as it also give information down to the city/county level.

Remember too, that the latter part of this decade will continue to see mass integration and mergers and this can be truly the hardest part of your information gathering process. When one plan is purchased by another (or usurped), their corporate identity changes and keeping track of them, or trying to find information on them, can be a nightmare.

The most positive outcome, recently, has been that more and more health care plans are beginning to recognize both the cost-effectiveness and true benefits of chiropractic care, so the number of plans offering chiropractic coverage is increasing all the time. What we, as a profession, may have initially seen as an effort to "shut us out," may, in fact, be turning around to include more of our care in the entire continuum of a person's health.

For more information regarding credentialing and on-site reviews, you may contact Dr. Bjerke at 319-323-5580 or HCHOICES@aol.com