MEDICAL EXPERTS EXPECT MANAGED CARE TO GROW IN COMING YEAR

Managed care will continue to grow as providers feel more pressure to contain costs.

James Sexton, president and CEO of St. Francis Medical Center, said he's sure more managed care companies will move into the region.

"I can't tell you who 'cause we don't know, but I'm sure it will be somebody," he said.

The managed care market has been volatile in the Cape Girardeau area in recent months. Humana HealthCare closed down its Cape Girardeau office and MedAmerica HealthNet, a physician-hospital organization of some 250 physicians and six hospitals, announced it was filing for bankruptcy.

"The jury's still out" on just what products will be available, said James Wente, administrator of Southeast Missouri Hospital.

"Some of the current thinking is that they are backing away from gatekeeper HMO models," Wente said.

In some HMO's, patients must get referrals from their primary care physicians in order to see specialists who may or may not be included in their HMO network.

Without a gatekeeper, patients have more freedom of choice in seeking care, Wente said.

"As a result of that, the modeling of managed care products will be affected by what consumers want, which, again, is choice," he said.

But more choice means higher costs, Wente pointed out.

As managed care becomes more prevalent, providers will have to become more competitive, Sexton said, bidding lower to win contracts with insurance companies.

"And the result is that the providers need to manage their costs more effectively in order to maintain some level of margin in the face of pretty stiff discounts," he said.

Managed care "seems to be driven by the payment side," Wente said, and subscribers might not be getting what they think they are paying for.

"I think there's a lot of work to be done in getting everybody's interests properly recognized," he said.

As the population ages -- Baby Boomers will soon be eligible for Medicare, Wente pointed out -- more health care services will have to be made available, he said.

"I think it may take another five to 10 years to really see how it's going to settle out," Wente said. "The real question in my mind is how is the federal government going to deal with this? What's Medicare going to look like?"

Outpatient services will continue to become more prevalent in the future, Wente and Sexton said.

"I think that trend is continuing to move," Sexton said.

Technology is part of that, Wente said, thanks to the development of more laparoscopic procedures, improved medications and testing and other issues.

But cost-saving is also an issue, Sexton said.

"I think there's also been just a shift in the medical management philosophy," he said, as providers and insurance companies look for ways to cut costs.

"I think the overall emphasis is lower costs," Sexton said.

Along with more outpatient procedures, Wente and Sexton both expect to see home health care and durable medical equipment usage increasing as people recover at home, rather than in the hospital.