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The state-appointed Managed Health Care Improvement Task Force has put forth more than 100 recommendations to improve the managed care industry in California. Here are its key recommendations.

Improve regulation

– Create a new state entity to regulate the managed care industry, relieving the Department of Corporations from that responsibility.

– Audit medical groups and other providers that bear significant risk for solvency and quality.

– Within two years, expand scope of new state entity to include regulation of other health insurers currently regulated by the Department of Insurance.

Serve patients better

– Seek ways to expand health care coverage and plan choice without raising costs.

– Eliminate incentives for skimming off low-risk patients and avoiding high-risk patients.

– Adjust capitated payments to reflect level of risk.

– Make health insurance contracts more understandable for individuals and small-group purchasers.

– Improve state’s data-collection efforts to enable quality comparisons between health plans.

Increase quality of care

– Allow women direct access to their obstetricians and gynecologists.

– Institute a dispute resolution process that is fair, easily understood and timely. Make sure it both resolves individual consumer’s problems as efficiently as possible and provides information to improve the health care system.

– Ensure state regulators develop expertise in assessing compensation arrangements between health plans and providers.

– Require continuity of care for chronically ill, acutely ill and pregnant patients when they involuntarily change plans or the provider is terminated for other than cause.

– Ensure extended, prolonged or permanent referrals to a specialist for enrollees with life-threatening, degenerative or disabling conditions that require specialized care.

– Convene a clinical expert panel to determine the best clinical practices and standards of care, as well as when and how to reclassify therapies from experimental to proven treatments. Panel should consider medical appropriateness in reference to treatment issues.

Increase information

– Require health plans to publicly disclose the scope and general methods and incentives paid to their providers.

– Require health plans to disclose, and the patient to provide prior consent for, the appointment of a provider other than the one the patient was assigned or chose.

– Provide significant additional information to consumers, including: a standard product description to facilitate direct comparison of plans, up-to-date and specific information on provider access, information on referrals to specialty centers, and treatment guidelines.

– Require health plans to inform consumers of their rights to prescription drugs.

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