Patients prefer doctors in open-model plans

Staff-model HMOs least popular with members

If you want satisfied plan members, allow your primary care providers to work with more than health plan, say researchers led by Dana Gelb Safran, ScD, director of the Health Institute of the New England Medical Center in Boston.

Researchers asked 6,000 Massachusetts state government employees who belonged to different models of health plans to rank the performance of their physicians in 10 categories, including access to care, continuity of care, physician’s knowledge of their personal health, and how well their physician communicated with them.

Patients of staff model health maintenance organizations, plans with salaried physicians limited to treating the members of that plan, ranked their physicians the lowest in nine of the 10 categories. The only category in which the plans did not receive the lowest score was for preventive health counseling. Group model HMOs, which limit physicians to treating only members but pay them differently, performed slightly better than staff model physicians in all 10 categories, but not as favorably as open-model health plans.

Open-model plans, which do not restrict physicians to treating patients in only one plan, scored highest in all 10 categories. Open-model plans include managed indemnity insurance, which works like traditional fee-for-service insurance with some controls such as preauthorization for hospital admission; point-of-service plans; and network HMOs. Patients reported no difference in the quality of care received under the various open-model plans.

(See: Safran DG, Rogers WH, Tarlov AR, et al. Organizational and financial characteristics of health plans: Are they related to primary care performance? Arch Intern Med 2000; 160:69-76.)