Ellen Thrower

After several years without a physical, Paige budgeted $150 to see a gynecologist. She found a doctor, made an appointment, and stepped into a nightmare.

Paige’s routine, cervical cancer-screening test came back abnormal. She was told a biopsy, costing $400, was necessary to draw a better conclusion. With no savings to speak of, she borrowed the money from a friend, hoping her fears were unfounded and the biopsy results would be normal.

No such luck. The biopsy revealed severely abnormal, precancerous cells that had to be removed at once. This surgical procedure would cost $950. Desperate, broke, and in debt, Paige pleaded with her doctor to arrange some sort of payment plan, but to no avail. Her only alternative was to apply for a loan at her bank, which she did. Luckily, she got the loan, underwent the minor surgery, and after spending a total of $ 1500, learned that she was okay.

The fact that Paige is now healthy makes her story a happy one, but the possibilities were frightening. “Facing the idea of cervical cancer was scary enough. Wondering how I was going to pay to find out if I had cervical cancer was downright terrifying.” Paige recalls.

If she had been on a good managed health care plan, a lot of the stress and possibly the whole incident could have been prevented. The lower medical cost to the patient might have prompted Paige to start seeing a gynecologist earlier. The gynecologist, in turn, might have been able to discover the abnormal cells before they became precancerous.

Like Paige, millions of people across the country are discovering the importance of choosing a managed health care plan. Although managed care has been around for years, few people understand exactly what it is. Simply put, it is a system designed to lower the nation’s medical costs while providing quality care. Within the system are plans that restrict people to specific doctors, or give them price breaks for going to certain doctors. This process can allow more control over treatments, which often results in disease prevention and cost containment.

There are two basic types of managed care: the HMO (Health Maintenance Organization) and the PPO (Preferred Provider Organization). HMO members pay a preset monthly payment and choose one primary care physician who decides what type of care they need and who will provide it. HMO members who see doctors outside of the network usually have to pay the entire bill. HMO’s put their physicians through a rigorous credentialing process. The aim is to cut costs by stressing preventive medicine and decreasing what they feel is unnecessary treatment. PPO members select any specialist in a certain network. Members who go outside of the network have to pay a larger portion of the hill. PPOs provide less restriction and more physicians to choose from, but at a higher monthly cost.

Deciphering the terminology, details, and countless options within HMOs and PPOs can be a grueling task. Fortunately, Dallas and Fort Worth contain the experts, organizations and institutions necessary to find a good managed health care plan that works for you.

CHOOSING THE RIGHT PLAN

The first step is to identify your needs and find out who can meet them. Enter Donny Lauderback and Katherine Stamper, whose Managed Care Store is the only one of its kind in Dallas.

Employers use them to extensively survey employee needs and shop every managed care plan in the Dallas / Fort Worth area until a perfect match is found. Their sen-ice, which is free of charge, doesn’t end once their client has selected a health plan. Lauderback and Stamper maintain relationships with their clients, and encourage them to contact the Managed Care Store with any questions or difficulties regarding their health plan. Such dedication often involves making doctor’s appointments for employees who need to he seen quickly, handling billing mistakes, and filing complaints when they feel a client has been treated inappropriately.

Lauderback and Stamper contend that the main mistake people make in choosing a health care plan is going by cost alone. Instead, people should he more willing to pay for an HMO that is driven by physicians who will stop at nothing to get their patients the care they need. “A good managed care plan is hands-off, but has doctors that are hands-on,” Lauderback adds.

KNOWING YOUR OPTIONS

Once you’ve identified what you or your company needs in a health care plan, it’s encouraging to know that health plan providers exist to fit those needs.



Innovation and variety are just two of the reasons United HealthCare was ranked as the nation’s most admired company in the health care industry by Fortune Magazine’s annual survey. A national leader in health care management since 1974, United HealthCare Corporation acquired the MetraHealth Companies in October. 1995.

“We can offer the whole spectrum of health care coverage programs,” says Richard Cook, CEO of the company’s North Texas office. That spectrum includes HMOs, PPOs, and POS (Point of Service) plans. In North Texas alone, 2,400 employers offer United HealthCare network-based products, using a network which includes more than 50 par-ticipating hospitals, 4,200 physicians, and more than 600 pharma-cies.

“Consumers are looking for more from managed care than just cost savings and quality health services,” states Cook. “They want a greater voice in decisions about their own health.”

United HealthCare listened to con-sinners’ continuing concerns regarding physician choice and access and responded by offering the first truly new approach to health care coverage in North Texas since HMOs were introduced. United’s open access plans – Choice and Choice Plus -take the best features of managed care -prevention, coordinated care, provider credentialing and cost-effectiveness – and combine them with unrestricted physician access. “This will set a new standard for managed care in the Dallas and Fort Worth area,” says Cook.

CIGNA HealthCare is one of the largest investor’ owned oper ators of HMOs and PPOs in the U.S., serving approxi mately 5 million man aged care members nationwide

Serving the Dallas and Fort Worth community since 1980, CIGNA Health-Care offers consumers a “mixed model” type of health coverage. CIGNA contracts with independent physicians, but also has its own freestanding health care centers, called Metro Medical Associates. These centers offer family practice, internal medicine, pediatrics, laboratories and pharmacies. “What makes us unique is that along with being financiers and administrators of managed care, we’re also caregivers,” says Tony Van Roekel, President and General Manager of CIGNA HealthCare’s North Texas office. “This gives us a sensitivity to and understanding of” the caregiver side of the business.”

CIGNA also has a health information department accessible 24 hours a day, 365 days a year. Customers can call from anywhere in the U.S., discuss their health issues with a CIGNA nurse, and obtain guidance in getting care.

GETTING THE BEST CARE



Once you have chosen a health care plan you are comfortable with, you can relax with the knowledge that the Dallas / Fort Worth area is home to a large variety of first rate hospitals and medical centers with services and specialties that will provide you the best possible care.



Baylor Health Care System is a regional network of affiliated hospitals, health centers, clinics and physicians serving the north Texas region since 1903. In 1995, more than 830,000 patients sought health care from the Baylor Health Care System- As the fourth largest not-for-profit, church-related medical system in the United States, Baylor’s success is based on a commitment to quality patient care, medical education, research and community service.

Baylor Health Care Systems flagship hospital is Baylor University Medical Center, a five-hospital complex located in Dallas that is one of the nation’s premier tertiary care, teaching and referral centers. Major medical service areas include organ transplantation, high-risk neonatology, cardiology, gastroenterology, orthopedics and oncology. Baylor Health Care System also includes Baylor Institute for Rehabilitation, Baylor Medical Center at Garland, Baylor Medical Center at Grapevine, Baylor Medical Center at Ellis County, Irving Health Care System, Baylor/Richardson Medical Center and Hopkins County Memorial Hospital.

In the age of managed health care, Baylor Health Care System recognizes that people need a choice. “At Baylor Health Care System, it is our position to participate in a wide variety of managed care plans so that self-employed individuals, employees of large corporations, and everyone in between can have access to our system,” says Russell Lackey, Director of Planning and Business Development. “Whether your interest is mote of a traditional health plan or an HMO type of plan, we want to make sure everyone has access to our quality care,” he says.

Without question, Children’s Medical Center of Dallas has made its mark as one of the nation’s leading children’s health care facilities. The 322-bed facility, with the largest staff of pediatricians and pediatric sub-specialists in Dallas, also has a pediatric intensive care unit, psychiatric unit, and state-of-the-art emergency center designed specifically for children.

A major pediatric kidney, liver, heart and bone marrow transplant center, Children’s Medical Center’s specializations also include hematology-oncology, cardiology, gastroenterology, and neurosurgery. While focusing on family-centered care, Children’s Medical Center is increasing outpatient services so that young children can recover in the comfort of their own homes.

Children’s Medical Center’s relentless dedication to children is also evident in the development of a new program, “Remember Your Children,” designed to help parents make sense of today’s multi-faceted health care industry. “As consumers, we’re very fortunate in Dallas and Fort Worth to have so many choices regarding health care,” says Sally Lyon, Director of Managed Care for Children’s Medical Center of Dallas. “Because each family’s needs are unique, we strive to help parents do their homework and make the best choices for their children.”

Doctors Hospital completed a multi-million dollar renovation and expansion of its facilities within the last year, furthering their role as a medical center focused on outpatient services and personalized attention. The hospital’s new Sports and Industry Care Center, designed for outpatient physical therapy, is equipped with an indoor heated pool, running track, weight training machines and equipment, and a therapy pool with wheel chair access.

The 268-bed facility, located in east Dallas near White Rock Lake, contracts with more than 30 managed care carriers and multiple physician groups. CEO Rob Freymuller believes that “whether you are selecting health coverage for your family or deciding which health plans in which your employees can enroll, you should ask the following question: Does the plan have convenient access to a broad selection of physicians and hospitals coupled with a rep-utation for quality care?”

At Doctors Hospital, the medical staff practice in numerous fields and specialties, including cardiology, family practice, inter-nal medicine, obstetrics and gynecology, oncology, ophthalmology, neurology, orthopedics, psychiatry and surgery.

Those who value a strong sense of comfort and community within their hospital should consider Presbyterian Hospital of Plano. “Our stockholders are our patients and the community,” says Jim Boswell, Administrative Director of Physician Services. Almost six years old, the hospital prides itself on a warm, comfortable and caring atmosphere where each room is private.

Presbyterian Hospital of Piano offers a wide variety of specialty services, including the Assistant Reproductive Technology Services (ARTS) program; spine and total joint rep lace -ment pro-grams; orthopedic and neuroscience services; psychiatric and sub-stance abuse programs for adolescents and children at the Seay Behavioral Health Center; and a Wound Care Clinic.

Expectant mothers appreciate Presbyterian Hospital of Pianos all-private birthing suites in which labor, delivery, recovery and post-partum all take place in the same room. Another special program called “Coughs and Cuddles” provides temporary daycare service for children with minor illness or injury preventing their attendance at a regular childcare facility.

Opened in 1974, Garland Community Hospital is an established and quality health care provider. Known for its surgical excellence, the hospital specialises in cosmetic and plastic surgery; general orthopedic surgery, with a heavy emphasis on the spine and neck; and ophthalmology surgery. The hospital was the first in Texas to use the “smart bomb” laser equipment, used for treatment of glaucoma.

CEO Dwayne Ray believes the personalized care practiced at Garland Community Hospital is important, unique, and worth consideration. “If you’re a patient here, you’ve not just a number. You have the same nurse or physical therapist tomorrow that you had today. We think patients should know exactly who will he taking care of them.” Ray points out that the hospitals physicians have had training in the larger medical facilities, hut have chosen Garland Community Hospital because of the caring and accommodating atmosphere,

Also worth mentioning is the hospitals strong behavioral medicine program for psychiatric and chemical dependency disorders, which is Garland’s only provider of mental health services.

Arlington Cancer Center is a comprehensive outpatient center dedicated to providing leading-edge diagnosis, treatment, research, education and support services to adult cancer patients. Services provided in the facility include medical oncology, hematology, diagnostic radiology, radiation therapy, chemotherapy, outpatient autologous bone marrow transplantation, laboratory and pharmacy services. These services are administered by an unparalled expertise of some of the nation’s leading oncology physicians, nurses and Ph.Ds.

Arlington Cancer Center has enjoyed a long-standing relationship with area managed care organizations, and is currently a preferred provider for more than 100 managed health care plans in North Texas. Alfred DiStefano, M.D., one of Arlington Cancer Center’s original founders and current Managing Partner, said, “Our goal has always been to give cancer patients access to advanced treatment options by offering a comprehensive scope of outpatient services, providing our patients convenience and an improved quality of life. With the growth of managed care, our outpatient focus has also proven to be the most cost effective treatment modality”

Arlington Cancer Center’s mission is to bring the most advanced and customer-responsive oncology diagnostic treatment services to North Texas, combined with a warm, caring atmosphere and treatment of the whole person.