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Making Provider Choices in Managed Care

How to make the wise choice in a primary care physician.
By
WebMD Feature

Under managed care, a primary care provider (PCP) wields considerable power. He or she is the gatekeeper who holds the keys to the specialized medical care you may need. Above this doctor, though, is the managed care plan itself -- the PCP's gatekeeper. The average consumers may think their most important health care choice is picking the right PCP. But other factors, including the plan you choose, have just as great an effect on your health care.

Choosing a PCP

Bob Blendon, PhD, professor of health studies at the Harvard School of Public Health, believes consumers today select their PCPs the same way they've always chosen doctors: Personal experience, a recommendation from a friend or coworker, or how convenient the doctor's office and hours are.

This approach is sound, according to the American Medical Association, which suggests similar criteria in its consumer publication, "Choosing a Doctor." The AMA also recommends selecting a PCP who shares your values about medical care, and interviewing the doctor before you make a final choice.

Yet although advice like the AMA's is a common-sense approach to the selection process, Blendon thinks it may give a false sense of security. "It's not clear to me that people know the power of their primary care provider, let alone the limitations their plans may have. People are confused," he says.

Blendon thinks consumers should redirect their attention to the plan itself, not necessarily the doctors who participate in the plan. "What matters more is how restrictive the plan is about seeing specialists, what kind of limitations are placed on prescriptions, and what incentives are paid to the doctors to keep costs down."

To complicate the choice, any particular doctor probably appears on the PCP lists of several different plans at once. Due to the multiple listings, explains Blendon, physicians can become confused trying to distinguish between plans. For instance, one plan may have more restrictions about medical testing, which may lead to your undergoing tests that your plan won't cover.

The Government's Role

State legislatures and the federal government have both been trying to regulate certain areas of health access. This is especially true where patient choice is involved.

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