MANAGED CARE TAKES HOLD IN SOUTHEAST MISSOURI REGION

The prognosis is healthy for managed care in Southeast Missouri.

HealthNet Blue, a managed-care product offered by MedAmerica HealthNet Inc. and Alliance Blue Cross Blue Shield, covers 19,600 people in the region, and Humana Healthcare Plans covers more than 8,000 people.

"We think Cape Girardeau is an excellent market," said Jim Floyd, manager of communications for Alliance Blue Cross Blue Shield. "There's very little managed care offered there. I think as more and more people see the value of managed care -- that it will work for them -- then the market will continue to grow."

Jeff Anderson, associate executive director for Humana Healthcare in Cape Girardeau, agreed that Southeast Missouri is an excellent market for managed care. But he said physicians in the region have been reluctant to accept it.

Dr. Bill Shell, a Sikeston physician and president of MedAmerica HealthNet's board of directors, said area doctors are getting used to the idea of managed care. "I think the physicians are starting to accept things," Shell said. "For a lot of them, MedAmerica is their first taste of managed care."

MedAmerica was formed in 1994. The physician-hospital organization (PHO) is a network linking the staffs and services of more than 200 physicians; St. Francis Medical Center and Southeast Missouri Hospital, both in Cape Girardeau; Missouri Delta Medical Center in Sikeston; Perry County Memorial Hospital in Perryville; and Dexter Memorial Hospital in Dexter.

The organizers of the PHO realized managed care would eventually reach Cape Girardeau, Shell said.

The network was formed to give physicians and hospitals "a little more control" in managing managed care, he said.

"It was not our intent to keep managed care out," Shell said. "Our main intent was that we would have at least some control in what was happening in Southeast Missouri."

In some areas where managed care is prevalent, competition between providers and hospitals for patients is pretty fierce, Shell said, and physicians who aren't members of managed-care organizations have access to small pools of patients. In addition, in some managed-care organizations, physicians and hospitals are pressured to reduce their fees for services.

"There's none of that type of thing here, although we all have been more aggressive in discounting our fees; but it's been an unpressured discount," he said.

Fee reductions made by member physicians are "not as much as some managed-care organization coming in and trying to reduce fees," he said.

"I think that there is an overall goal of trying to reduce and control hospital charges and physician fees," Shell said. "I think we can do it without some managed-care group coming in and taking 15 percent or 20 percent off of all income or fees."

MedAmerica has done better than its organizers anticipated, he said, and he fully expects to see more managed-care providers setting up shop in the region. "Things are going to change," Shell said.

Mary Dunn, executive director of the SEMO Business Group on Health, calls the growth of managed care in the region wonderful. "It means there are a lot more choices out there" for employers and patients, she said, while helping businesses control health-care costs.

Dunn said she expects to see an HMO option made available in 1996 or 1997.

James Wente, administrator of Southeast Missouri Hospital and vice chairman of MedAmerica's board, called the forecast for managed care "positive." But, Wente said, it is important to balance cost savings and quality of care when shopping for managed care -- whether the shopper is a business owner looking at what options to offer employees, a patient seeking care, or a hospital administrator trying to decide whether to accept a managed-care plan.

"I think it's very important to recognize that all of us who are involved in the delivery of health care are part of the community, and are very committed about maintaining and improving the health status of our community and our region," he said. "I'm not interested in just discounting our services wholesale to whoever comes along. It has to be a two-way street, and it has to be something that's good for our patients and doesn't threaten the financial status of the hospital over the long haul."

Wente said, "The quality issue and the patient's rights and the patient's election for the physician that they want and the hospital they want to choose" are central issues in choosing a health plan.

John Fidler, president and chief executive officer of St. Francis Medical Center, said: "I think the future of managed care will be increasing partnerships between employers and providers. I think we'll see more direct contracting for services with employers" and more shared risk between providers and employers.