BY TIM BONFIELD
The Cincinnati Enquirer
The sudden emergence of United HealthCare Corp. as Greater Cincinnati's biggest managed-care health insurer drew mixed reactions Friday from doctors who have dealt with the company.
"They're not any worse than anybody else," said Dr. Albert Malcolm, a Middletown oncologist. "If anything, they're a little bit easier to deal with than some other plans."
A giant player nationally, United had been a small but fast-growing health plan in Greater Cincinnati until Thursday. That's when United announced a proposed $5.5 billion acquisition of Humana Inc.
The deal will catapult United to the top of Cincinnati's market because last year Humana acquired ChoiceCare, the city's biggest HMO. Assuming the deal passes regulatory review, United's local enrollment will jump from 70,000 to about 380,000 members.
Among the positive reviews:
Families will like United's policies about seeing specialists without requiring referrals from a primary care physician. Employers may like United's high customer satisfaction rates and its efforts to track quality measures. Doctors report encountering fewer hassles with United than many other health plans.
Among the concerns:
Employers fear the Humana acquisition will reduce competition, making it harder to shop around for health benefit deals. For patients, it remains too early to tell how the acquisition will change benefits or provider networks.
Meanwhile, doctors have been critical of United's efforts to promote an emerging form of physician compensation called capitation. The basic idea is to pay doctors a flat monthly fee in advance for each member they serve. But there is no pay, or vastly reduced pay, for treating patients once they get sick.
If the monthly payments exceed the costs of care, doctors keep the profits. Proponents say this gives doctors an incentive to be as efficient as possible. Critics say capitation gives doctors an incentive to deny care to sick people.
Specialists like United's open-access policies, but some have criticized United's capitation contracts. In Dayton, Ohio, dissatisfaction with United and other managed-care issues prompted some specialists, mostly orthopedists, to start a union.
"We've had good and bad experiences with United," said Dr. Greg Gerber, a gastroenterologist and chief of the medical staff at Middletown Regional Hospital.
"I would warn Cincinnati doctors to be very cautious about capitation."
While suddenly huge in Cincinnati, United HealthCare is not new to Ohio. The company entered Ohio in 1992 by acquiring PHP Benefit Systems, a large Columbus-based health plan. Then in 1993, it entered the Dayton market by acquiring the Western Ohio Health Care Corp. Both health plans were similar to Cincinnati's ChoiceCare HMO. Initially unable to acquire ChoiceCare, United launched its own HMO in Cincinnati in April 1995, which rapidly grew to 70,000 members.
