[Congressional Record Volume 144, Number 1 (Tuesday, January 27, 1998)]
[Extensions of Remarks]
[Page E1]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]




                 FULFILLING THE PROMISE OF MANAGED CARE

                                 ______
                                 

                        HON. FORTNEY PETE STARK

                             of california

                    in the house of representatives

                       Tuesday, January 27, 1998

  Mr. STARK. Mr. Speaker, my bill H.R. 337 establishes consumer 
protections in managed care plans--just like many other bills currently 
pending before the Congress.
  One unique feature in H.R. 337, however, is the requirement that when 
a managed care plan enrolls a person, they must soon do a health 
profile or work-up on that person. Medicare and private insurance plans 
pay an HMO hundreds of dollars a month to ``maintenance'' an enrollee's 
health. But how can the HMO provide maintenance or preventative care 
(such as immunizations, mammograms, etc.), unless it sees the enrollee 
and establishes a health benchmark on the person?
  My legislation is designed to ensure that HMOs really do maintain 
people's health. By scheduling an appointment and the collection of 
basic health data, the HMO can truly begin to provide managed care 
health. It can determine whether the person is a smoker, overweight has 
high cholesterol, is diabetic, is facing glaucoma, etc. Once these 
benchmarks have been established, the HMO can begin the counseling or 
the other services needed to ``maintain'' or improve health--thus 
fulfilling the promise of managed care.
  The November 5, 1997 issue of the Journal of American Medical 
Association (JAMA) contains an article, ``The Relationship Between 
Patient Income and Physical discussion of Health Behaviors,'' which 
states, ``Although unhealthy behaviors were common among all income 
groups, physician discussion of health risk behaviors fell far short of 
the universal risk assessment and discussion recommended by the US 
Preventive Services Task Force. We conclude that the prevalence of 
physician discussion of health risk behaviors needs to be improved.''
  If physicians would do more to counsel their patients especially the 
lower income, these individuals could receive adequate and informative 
health care advice. As the JAMA article said, ``Physicians also need to 
be more vigilant in properly identifying and counseling low-income 
patients at risk. Increasing the prevalence of physician discussion of 
health risk behaviors could greatly affect productivity, quality of 
life, mortality, and health costs in the United States. If the nation 
is truly interested in health improvement, a multifaceted approach is 
required to diminish the social gradients in health related to 
education, income, housing and opportunity, including a more effective 
national system for preventive services (Papanicolaou tests, breast 
examinations, immunizations) as well as improved discussion of health 
risk behaviors.''
  For instance in the case of smoking the JAMA article states: ``Our 
data indicate that 49% of all patients with whom behavioral discussions 
occur attempt to cut down or quit smoking based on their physicians' 
advice and 49% of those who report attempting to change behavior no 
longer smoke. . .increasing the prevalence of physician discussion of 
smoking by 50% would result in a 6% decrease in the prevalence of 
smoking. Based on mortality and cost estimates of smoking, this 
reduction in smoking could potentially result in 24,000 annual deaths 
delayed and a $3 billion annual cost savings to our society.''
  The December 3, 1997 issue of JAMA, contains an article, ``Cost-
effectiveness of the Clinical Practice Recommendations in the AHCPR 
Guideline for Smoking Cessation,`` which states that ''Tobacco use has 
been cited as the chief avoidable cause of death in the United States, 
responsible for more than 420,000 deaths annually, Despite this, 
physicians and other practitioners fail to assess and counsel smokers 
consistently and effectively.'' Again, an HMO would be the ideal 
setting to help a person stop smoking, but they can't do it if they 
don't see the patient--and that's why we need H.R. 337.
  As we start to pay HMOs thousands of dollars a year for maintaining 
health, let's make sure that they at least see the individual and do 
something to earn these payments. If the premise of managed care is 
correct, then H.R. 337's early profiling and subsequent counseling will 
save the HMOs money in the long run by avoiding future expensive acute 
care services.

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