Conference 7.286::digital

    
    I've had no problems with Fallon. As a matter of fact, I was recently
    in Marlboro Hospital's emergency ward. Fallon paid for everything;
    the ambulance, the x-rays, the stitches, etc...
    
    I'm happy.
    
    /prc

    Fallon Community Health Plan
    
    Our assessment: 
    	well-patient care: Very good 
    	emergency care:    Good
    	critical care:     excellent
    
    Well patient (check-ups, referrals, etc)
    	Our experience is that Fallon does this well. We are very pleased
    	with the quality of our doctors, and have found that they will
    	refer us to experts when needed.
    
    Emergency care:
    	Requires some travel as 'local' offices are closed on weekends.
    	Use St. Vincent's in Worcester. Was apprehensive at first but after
    	several trips there (broken bones, minor stuff) we have no 
    	complaints. Can be a wait for treatment.
    
    Critical care:                                                            
    	Excellent. Our son was treated for critical/terminal illnesses
    	for 6 years at a cost of close to $500K. Fallon reviewed the case
    	at the outset, with ourselves and experts and agreed to pay for
    	all treatments approved by our doctor. They even approved an
    	experimental surgery in San Francisco...was actually done in Boston
    	by an (expensive) consortium from all sorts of hospitals. They
    	paid for all this with no problem. Also initially approved
    	having care being given by UMass Medical rather than St. V's, as
    	they had more expertise in problem, and later yet approved moving
    	care to Children's, again with no problem.
    
    Obviously we're pleased with Fallon.
    
    Tim
    

  People interested in comments on HMOs as well as comparisons to the
  Digital Medical plans may want to check out the following other
  topics as well. There has been quite a bit of HMO discussion here
  over the years.

			Alfred

   212   WORDS::BADGER        6-NOV-1986    62  more push to HMOs
   254   TIXEL::ARNOLD       16-JAN-1987   108  John Hancock
   260    RUBY::KELLY         1-FEB-1987     3  Unfair Policy
   311  NUTMEG::RYAN          7-MAY-1987    14  <<< HEALTH CLUB BENNIES?? >>>
   322     BMT::COMAROW       6-JUN-1987    10  Gaps in John Hancock Coverage
   490   GRECO::MAURER        9-MAR-1988    20  Fallon Comments please
   501  WINERY::BOUCHARKE    25-MAR-1988    37  HMO vs HANCOCK...
   723    VINO::DZIEDZIC     10-FEB-1989     3  HMO Choice - Pilgrim vs CMHC

    re: .1
    
    Hmmm.  "Happy" is not a word I would choose to describe my feelings
    about an event which required an ambulance, x-rays and stitches to
    consummate.  But then, I'm not you, which is probably fortunate for
    both of us.
    
    Al
    
    P.S.  ;^)
    

There's also a discussion on various HMOs going on in VMSZOO::MEDICAL.
Check out the last several notes.

    Anyone have any comments on the New Hampshire based HMOs?  
    
    In particular the Nashua/Merrimack based HMO's ie; Matthew Thorton,
    Harvard Community, and Healthsource. 

    I would appreciate any comments re: Harvard HMO in
    Chelmsford/Acton/Concord areas.  I attended the open house
    at the Harvard HMO in Chelmsford - and was turned off by:
    
       - "salesy" presentation 
    
       - evasive responses to questions about patient/doctor
         ratios, average amount of time  that doctors
         spend with a patient
     
     I also hear a lot of HMO advertising (particularly from
     Tufts HMO) and hate to think that this is were some
     of the patients' money is going.
      
     I have been fortunate up to now to pick those doctors
     and services that I found best suited me - (like Dr.
     Childs in Maynard who will spend several hours with
     a patient if necessary)
    
     The HMO looks like a mass production business: lets-
     get-as-many-people-in-and-out-as-fast-as-we-can kind
     of operation.  I think the HMO might be a better
     match for large families or families with kids. Being
     able to quickly reach a team of pediatricians is
     a valuable benefit.  But for couples without children
     or single people they seem to be less appealing.
    
     I am obviously biased - so would appreciate any views
     
    
    d

    As Action Medical had recently become part of Harvard (Multi Group as it 
    was then) I joined the HMO when offered by DEC.  This was some 7 years 
    ago and I was in the middle of treatment for a specific problem.  
    There was a distinct difference in the level of care before and after 
    joining HMO--but that was the past.  
    
    After many negative experiences, and many hundreds of dollars spent on
    private and much needed medical care, with Harvard HMO I rejoined the 
    DIgital Medical Plan two years ago. 
    
    I don't visit my doctor very often but when I recently fell to the bug
    of popular choice recently I developed my usual bronchitis (I always get
    bronchitis and if it's not treated it rapidly becomes pneumonia).  
    My doctor's attitude was "take two asprin and DONT call me in the 
    morning".  You would think that all I had was a splinter or something.  
    To my surprise I had to REALLY push to get anything done.  When I noticed 
    the error on my file I pointed out that I was no longer an HMO patient, 
    the attitude was somewhat different as was the treatment.
    
    In seven years nothing had really changed.  Expensive though it is, I
    will be staying with the Digital Medical Plan, it's cheaper in the long
    run.
                                          

    Let me preface my remarks by stating that I am generally a "read only"
    noter.
    
    For the past several weeks, I have been reading a great many "HMO
    bashing" notes.  As a member of Harvard Community Health for the past
    eight years, I have finally gotten to the point where I have to add
    my 2 cents worth (for what it's worth).
    
    In the past two years I have had a number of medical problems, including
    a badly sprained back, whiplash syndrome (from an auto accident) and
    stomach problems.  I have gotten, what I consider to be excellent care
    thru my primary care physician as well as numerous specialists.  I
    have had MRI's, CT scans, Upper and Lower GI series, and an
    Ultrasound.....total cost of which to me was......$0.00.  At no time
    was I seen by a clinical assistant when I should have seen a doctor.
    Contrary to wht I have read many people write, I would not consider my
    treatments and care to have been conservative.....if my doctors thought
    it necessary, I got it.
    
    I also have a daughter who was born with Down syndrome.  HCHP and her
    primary care physician make sure that she gets whatever is necessary
    for her health needs.  She has been referred to a pediatric
    cardiologist at Childrens Hospital for an ASD (small hole in the
    heart).  Whenever she gets a cold she is supposed to go on antibiotics
    (as it could rapidly develop into pneumonia) and all we need to do is
    call and we get the prescription and, if necessary, an immediate
    appointment.  The primary care physician (who is also my son's primary
    care physician) has become a valued friend and if we had our choice of
    any pediatritian would chose her in a minute.  She has exhibited a real
    willingness to further her knowledge of the special medical needs of
    children with Down syndrome.
    
    I could go on and on with more examples of the excellent care and
    attention that we have gotten from HCHP, but I think you get the
    general message.  My wife and I would not even think of changing and
    would recommend HCHP to any one, based on our experiences.
    
    	Steve

    I'm not being paranoid or anything but, the quality and extent of care 
    from any doctor, HMO or not, depends on the level of accountability in
    regard to a law suit.  There are other factors such as, are you a
    senior person in a large and local company, or a child.  Children get 
    reasonable care, but, this also depends on the parents social clout and 
    their ability to fight for what they need.  Women often get the biggest
    run around--especially of you are over 40, but this can be said of many 
    non HMO doctors also.
    
    The Harvard Comm. in Harvard Sqr. is great, Action Medical Associates
    lost a great deal of TLC after they moved into the new building, my
    chief complain was that I never saw my own doctor unless I wanted to
    wait two weeks for an appointment.  Concord Hillside has one or two 
    good doctors and a couple that I would not take a head cold to. 
    
    No matter what is said to the contrary, you receive better care if you
    are covered by a non HMO insurance carrier.
                                

I have had two serious medical problems treated by Matthew Thornton Health
Plan during the 7 years or so I've been with them.  One was chronic bronchitis
that they diagnosed as asthma (a diagnosis missed by other doctors I'd been
to with pulmonary complaints over the past 10 years, BTW) and successfully
treated with a 1-year course of medication.  The other was a broken finger and
subsequent 2-month course of occupational therapy to restore function.

In both cases, I received prompt, courteous, and competant medical attention.
There was no paperwork to fill out nor any hassles about payments (I didn't
have to co-pay anything for either of these two events).

--PSW

Re: earlier replies

Anecdotal evidence, especially the stories that appear in this conference, are
all very interesting, and I suppose it could be argued that in time the weight 
of the evidence leads to some clear conclusion, but the bottom line (it seem's
to me) is that what happened to someone else isn't all that useful. It all boils
down to individuals and every case is unique.

When I moved to New Englang with Digital in 1972, our family used the Southboro
medical group for all our medical needs. We had had previously very positive
experiences with the Kaiser Permanente group in California (who are considered
to be among the pioneers in the entire HMO concept). and looked for a group
practice. We used Southboro for years under the John Hancock plan and later,
when they became part of an approved Digital HMO, switched to them as an HMO.
Our level of medical care did not change, only the way we paid for it.

For me, the issue boils down to finding a doctor whom you trust and then
figuring out what financial/administrative plan covers that care. It's obvious
that some people have had bad experiences and have an entirely different 
perspective than I do.

Since I left New England 4� years ago, I don't know how the HealthNet issue 
would have affected me. I DO know that HMOs vary widely in different geographies
and that HMO coverage does not suit our medical needs today, so we'll stick
with a Digital Plan for 1991.

	/Marvin

        I agree with .12 that each case is unique.  But HMOs tend to
        provide better care than other HMOs.  If you want information
        about an HMO you are interested in, ask your personnel
        representative for the name of the Digital liaison of the HMO
        you are considering.

        The liaisons should have figures like `significant complaints
        per 1000 employees enrolled', and this information would be much
        more useful than a few random random stories in a conference.

        Re: .10

>    No matter what is said to the contrary, you receive better care if you
>    are covered by a non HMO insurance carrier.

        This may be true in general, but it can't be said on a
        particular case (as demonstrated from previous replies to this
        note--especially the one where a family joined an HMO and kept
        the same physician).

        As for it being true in general--do you have any figures to back
        up this statement?

        					B.J.

RE: .13 (.10)

>        Re: .10
>
>>    No matter what is said to the contrary, you receive better care if you
>>    are covered by a non HMO insurance carrier.

This certainly isn't the case for preventive care or education programs.  My
HMO runs several such programs, none of which are covered under traditional
insurance plans.

About the only rationale for this assertion is that traditional insurance
usually places no restrictions on which physicians one may visit, and thus
the option of seeing the best specialist for a particular problem is always
open to you.  However, things can cut the other way.  If a HMO physician refers
you to some treatment program, you know that the HMO is going to cover it.
In the case of my finger injury, for example, it's likely that with traditional
insurance that I would have had to delay starting occupational therapy (with
resulting possible permanent bad effects on my eventual recovery) while I
hassled with the insurance company over whether it would be covered.

There are also some areas where the best physicians happen to be associated with
the HMOs rather than in private practice.  The Nashua, NH area was one of these,
according to a classmate of mine who is now a family practice physician.  In
these cases, the best care isn't available UNLESS you are a HMO member.

--PSW

One other rationale for the assertion that non-HMO care generally has a higher
satisfaction level would be that you can always threaten to leave.  HCHP did
not X-ray my back (chronic pain) until I told them I was leaving.  I think
they did it then because I was annoyed enough at that point that they had good
reason to fear a lawsuit if I found something treatable after leaving.

The other reason (oh well, did I say one reason?) for more satisfaction is
purely psychological.  I'm making my own choices right now, so I don't have
anyone to blame but myself if I get poor care.  I also take comfort in the
fact that I COULD go to any doctor I want to.  So what do I do with my JH
insurance?  I go to "Health Stop" or "Regional Emergency Medical Center" and
get exactly the same kind of assembly-line treatment I would get from HCHP.

The more I think about it, the more I like HealthNet.  It gives you a
"favored" assembly line, and it gives you the satisfaction of knowing that
you don't have to go there. :-)

Let's assume that
.14> There are also some areas where the best physicians happen to be associated
.14> with the HMOs rather than in private practice.

The doctors must still work within the guidelines (and limits) the HMO sets
forth for them. Wonderful doctors + defined business practices may not
necessarily equal the best possible health care.

						Trace

From what I have read here and in other conferences, it seems that people in
the Northeast and possibly the West Coast are the most satisfied with their
HMOs.  It's the area inbetween that seems to generate the most negative comments
concerning HMOs.

Bob

re .15:

>                       I'm making my own choices right now, so I don't have
>anyone to blame but myself if I get poor care.

Of course, you can only base your actions of your gut feeling and (presumably)
limited medical knowledge.  It's all too easy to think a physician is
competent because he's personable.

    .15
    
    The disadvantage of Health Net is that the HMO still gets paid whether
    they treat you or not.  In fact, they are better off!

    
    I have been with Fallon for 3 years and have found their services to be 
    much easier to deal with than finding a variety of new physicians when
    I moved here.  However, I too have been put off by the 5 month wait for
    a physical.  When I first joined, it was 2 to 3 weeks and now we're out
    about 5 months.  Is this a decline in service?  Up until recently, I
    had been very satisfied with Fallon.  
    
    Susan

    
    RE. Fallon/physical
    
    I think that a physical is just on the bottom rung of Fallon's priority
    ladder.  I've always been told "months" for a physical.
    
    Once, I had a small problem I wanted checked out at just around the time 
    I was due for a physical.  I called and tried to combine the two into
    one visit, and the receptionist said I could come in that day for an 
    "office visit" to have my problem checked, but she couldn't schedule me 
    for a physical until a couple months.  ??!!
    
    - Sean