Health Against Wealth by George Anders

Author:George Anders
Language: eng
Format: epub
Publisher: HarperCollins

9. HMOs and Mental Health

EVERYTHING IS FINE. There are no problems here.

Throughout late 1994 and early 1995, Rhode Island state investigators Linda Johnson and Alison Woodbine kept hearing that message from executives as they scrutinized United Behavioral Systems of Rhode Island. Executives at the managed-care company wrote testy letters and made chilly remarks whenever Johnson and Woodbine pressed them about growing complaints that UBS was shortchanging its members. Their righteous defense sounded plausible at first. UBS was a newcomer in New England, having arrived only in 1993. But it was part of a well-regarded multistate HMO, Minneapolis-based United HealthCare. Within the United empire, UBS played a limited yet crucial role in more than a dozen states. It was a “carve-out” company, one that takes a specialized piece of the health-care market—in this case mental health—and applies managed-care principles to it.

Like any managed-care company, UBS was a powerful rulemaker, deciding exactly how much treatment it would underwrite for each patient. Some people wanted weekly or monthly therapy sessions to deal with depression, anxiety attacks, or other problems. Some were candidates for psychiatric hospitalization or multiday stays at alcohol-treatment centers. All these cases were funneled to UBS, which decided who deserved coverage, who didn’t, and how many therapy sessions or hospital days it would pay for.

In its marketing materials UBS implied that good care and saving money went hand in hand. “Our goal,” the company declared in one brochure, “is simply stated: To help people receive appropriate and coordinated care sooner; improve faster and stay well longer at a lower cost than they would in any other system.” And on paper UBS’s system looked impeccable. Soon after entering Rhode Island, the company hired a well-known local psychiatrist, Daniel’S. Harrop III, as its statewide medical director. Local employers rushed to sign up with United HealthCare and UBS, attracted by low rates and seemingly generous benefits. UBS grew rapidly, providing mental-health coverage for nearly 200,000 people in mid-1994. Clients included Fleet Financial, the Hasbro toy company, and the state of Rhode Island itself.

Nonetheless, disturbing reports about UBS’s methods surfaced in 1994, during the program’s second full year in Rhode Island. The managed-care company was saying no to mental-health treatment far more often than Rhode Islanders had expected. In some cases UBS’s denials were so blunt and unexpected that angry patients and psychiatrists took their grievances to the state Department of Health. As complaints mounted, two state officials began to investigate. Linda Johnson, a one-time HMO manager herself, had worked for the state of Rhode Island since 1987, looking into all aspects of wrongdoing in health care. She became the “tough cop.” Everything about her—her aggressive questioning, no-nonsense suits, jet-black hair, and slightly raspy voice—suggested that she wasn’t someone to tangle with. Her younger associate, Alison Woodbine, came across as the earnest rookie investigator, calmly but persistently pressing her inquiries.

In February 1995 Woodbine made full use of Rhode Island’s authority: she asked to inspect complete medical records for more than 40 randomly chosen cases in which UBS had denied care.

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