And so long as the drive for consistency is linked to providing better quality medical care, it benefits everyone. The best managed care organizations understand that medical quality and cost control are not incompatible. Doing what is best for the patient, even if it is expensive in the short run, leads to better outcomes, higher levels of patient satisfaction, better morale on the part of physicians. At the state level, there have been a variety of approaches to using the regulatory process to make managed care organizations accountable for the way they make clinical decision, the incentives they use to shape physician behavior, and the way they communicate with patients. In California, the nation's most advanced laboratory when it comes to managed care, two important principles have emerged.
Disclosure is crucially important.
The standards, practice guidelines, coverage limitations, and so forth, that managed care organizations use should not be a black box. Patients and their doctors should know what's covered and what's available. Moreover, disclosure should be active not passive. That is, the rules should not be fine print, but communicated dynamically, when they are relevant to treatment decisions. A timely appeals process for coverage denials is essential .