From Wake Forest University Baptist Medical Center
Wake Forest professor to evaluate managed care patient protection laws
Winston-Salem, NC - The Robert Wood Johnson Foundation has awarded a $583,964 grant to Wake Forest University School of Medicine to support an evaluation of managed care patient protection laws, under the direction of Mark A. Hall, J.D.
"This information will assist lawmakers in crafting and improving patient protection laws and their implementation and enforcement," said Hall, who is both professor of public health sciences (social sciences and health policy) and professor of law.
He said the study's main focus is "how these laws affect the attitudes and behaviors of patients, providers and health plans." He emphasized that economic costs are not the main focus. But among the issues are: do the laws allow patients to appeal denial of coverage, or to pick their own specialists, or to sue their insurers if something goes wrong with the treatment?
"Over the past few years, almost every state has enacted a variety of laws intended to protect patients against possible abuses from managed care organizations," Hall said. "Similar proposals are pending in the federal Congress, and were a major point of controversy in the recent presidential election. This study is an opportunity to use the initial experience under state laws to better inform the national debate."
Hall said the major questions to be answered in the study include:
- Have these laws increased patient satisfaction and improved the conditions for medical practice?
- Are there fewer complaints from members of managed cared plans, and how well are they resolved?
- How have these laws affected the structure of health care networks, corporate structure, and contracting techniques used by providers?
- How have the laws affected litigation, medical care management techniques and risk management activities?
- Can various effects be attributed to these laws, apart from economically driven corporate strategy, and how do legal and market factors interact with respect to these effects?
- Are these laws adequately enforced?
Hall said the three-year study would use a combination of quantitative and qualitative research techniques to evaluate managed care protection laws.
Hall said he first plans to develop a detailed index of patient protection laws in every state. "This index will be made available to other researchers to enable more rigorous quantitative assessment of these laws."
Preparing the index will take much of the first year of the study.
Second, he plans to use the Community Tracking Survey - also being done with Robert Wood Johnson Foundation funding - to assess the impact of managed care "on patient satisfaction and trust, access to care, ease of referrals to specialists, constraints on medical decision making and the use of financial incentives."
Six states reflecting a range of legal and market conditions will be selected for in-depth case studies. These case studies will involve extensive interviews with regulators, consumer advocates, employee benefit managers, insurance agents, and private lawyers and with managers and lawyers at national, regional and local health plans.
These two efforts will occupy much of the study's second year.
In the third year, the projects will be analyzed and the results widely disseminated to the news media, public policy and academic audiences.
Hall said the study was being conducted with the support and cooperation of the Health Insurance Association of America.