Monday, April 26, 1999

Changes to
QUEST address
patients’ rights

Options of patients are
increased during the
enrollment period

By Helen Altonn


Two of the health plans offered to Hawaii QUEST clients have changed some physician contract provisions to satisfy concerns over patients' rights.

The state's Hawaii QUEST program provides managed-care health coverage to about 130,000 eligible low-income families.

The nonprofit Hawaii Coalition for Health pushed for changes in Aloha Care and Kapiolani HealthHawaii contracts before an annual plan change period May 1-15.

Two major provisions opposed by the coalition are being eliminated: one that allowed physicians to be terminated without cause, and another that required terminated physicians' patients to remain in the plans. Other problems also are being corrected, said Dr. Arleen Jouxson-Meyers, coalition president.

She said the contract changes increase the options of QUEST patients during the enrollment period -- the only time this year they can change from one plan to another.

"There are still nitty-gritty problems with the contracts, but I think we can work them out," she said.

Until Aloha Care and Kapiolani HealthHawaii agreed to revisions in the past few weeks, the Hawaii Medical Service Association offered a better plan, she said.

However, the state Department of Human Services limits HMSA to 30 percent of QUEST patients on Oahu and 40 percent for the Big Island, she said.

It already has hit those caps, she said. "So nobody on Oahu or the Big island can switch over to HMSA. We have real problems with the department capping HMSA," she said. "It really interferes with patient choice."

Med-QUEST Division Administrator Chuck Duarte said other providers complained in past years about one plan with a majority of enrollees.

"That creates problems with competition," he said, "which is why we posed that cap and it's supported by the federal government. They don't want to see one plan dominating the market either."

The coalition has been working with Aloha Care and Kapiolani HealthHawaii for about a year to get changes in their contracts, Jouxson-Meyers said.

Aloha Care's plan focuses on QUEST patients and has about 25,000 dental members and 30,000 medical members, said Executive Director John McComas, pointing out that the plan has sought ideas, concerns and criticism from physician groups.

Kapiolani HealthHawaii is a partnership between Kapiolani Health and Physicians HealthHawaii Inc.

Dr. Kevin Hara, president and chief executive officer of the physicians group, said it asked Jouxson-Meyers to suggest language for contract modifications.

"We just want to put in language that's fair to all," he said.

The coalition fought HMSA about 1 years ago over a number of features of its physician contract. Agreement was reached on some changes, and discussions continued on others.

Jouxson-Meyers said HMSA distributed a new contract at the end of March that is "really quite decent." Physicians can't be terminated without cause, and there's no provision saying patients of a terminated doctor belong to HMSA, she said.

She said the contract has other advantages and that HMSA agreed to talk to the physicians about further changes.

Duarte said his division has sent survey forms to physicians to find out how health plans are working for them and patients.

Other health plans offered to QUEST patients are Queen's Health Care, Kaiser Permanente QUEST and StraubCare Quantum. Aloha Care, HMSA and DentiCare offer dental benefits.

HMSA's medical plan is offered this year on Maui and Kauai instead of Queen's Hawaii Care. Kaiser Permanente's medical plan won't be available on the Big Island. HMSA's dental plan will be offered on all islands.

Members enrolled in medical plans that won't be available must switch to another plan in the change period. At least two plans will be offered on each neighbor island.

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