Managed care.

• Author: Holloway, Constance
• Position: North Carolina

The changes it has brought to health care go far beyond controlling costs.

Perhaps no other factor influences how North Carolinians take their medicine more than managed care. Banned by state law until the 1960s, managed care could be North Carolina's most-competitive business enterprise of the '90s.

While attention remains focused on its profits and size, managed care is advancing in other ways as well. Long associated with restrictions on the doctor-patient relationship, managed care these days is about choice. In North Carolina, employers and employees are growing accustomed to a plethora of options: type of plan, what benefits it covers and the out-of-pocket costs employees pay.

Another shift is toward open access, in which some plans no longer require patients to go through a primary-care physician. Access also involves whether a health-maintenance organization has evening and weekend hours and how long it takes to schedule appointments. For example, Kaiser Permanente members needing urgent but not emergency care are seen by a doctor that day. Routine appointments require a three-day wait; appointments for preventive care, two weeks.

As the market continues to grow, managed-care companies will be challenged to offer quality health care along with an expanding range of options at competitive prices. That's good news for employers and employees. The greater the number of companies offering managed-care products, the easier it will be for businesses to choose programs customized to the needs of their employees.

"There's a variety of products that a payer can take to their clients," says Ken Stanford, executive director of HealthMark Inc.'s Charlotte regional office. "We offer more different products within managed care than we used to ofter. Five years ago, we offered a PPO [preferred-provider organization] and a type of point-of-service project. We still offer those two products," he says, but also provide case management and review services.

HealthMark has 104,660 PPO members in North Carolina and 8,344 in South Carolina. In January, it will be acquired by HealthStar Inc., a Chicago-based PPO operating in about 20 states.

Like HealthMark, WellPath Community Health Plans offers more than a few choices. "We offer a full-product spectrum," says Sandy Scherer, director of public relations and marketing communications. Products include HMO, PPO, POS, multi-option and indemnity. There's also life, accidental death and dismemberment, and short- and long-term disability insurance. "And we're working on offering Medicaid and Medicare HMOs," she adds.

WellPath, a joint venture of Duke University Medical Center and New York Life Insurance Co., serves 91,800 HMO and PPO members in North Carolina. Licensed in North Carolina since 1995, the company employs 155 in Chapel Hill and Charlotte. It's also seeking a license to operate in South Carolina.

Cigna HealthCare of North Carolina, with offices in Charlotte and Raleigh, has...