PANEL CALLS FOR HMO AGENCY; INFORMING PATIENTS HOW DOCTORS GET PAID ALSO AMONG TASK FORCE PROPOSALS.

Byline: Paul Hefner Daily News Sacramento Bureau

California should create a new agency to oversee the burgeoning HMO industry and require managed-care plans to tell consumers how doctors are paid, members of a state task force agreed Monday.

The panel also called for disputes between patients and their health maintenance organizations to be reviewed independently and for establishing standardized health insurance contracts so consumers can better choose among competing plans.

The recommendations are among 64 proposals a Managed Care Improvement Task Force agreed to submit to Gov. Pete Wilson and the state Legislature. The 30-member panel concluded its work Monday after months of sometimes contentious debate.

But even as the panel endorsed a summary of its findings, the group's work came under fire from both business leaders concerned about costs and consumer advocates who favored bolder reforms.

``The recommendations of the task force are modest at best. In the end, basically a whitewash,'' said Dr. John Roark of the California Physician's Alliance. ``Every day, I see HMOs making money at the expense of my patients.''

Legislation approved in 1996 created the panel, which includes officials from health plans, employers, doctors and consumer groups. Some members said the group did a good job of balancing competing interests.

``I think the task force has done a good job under difficult circumstances,'' said Steven Zatkin, a Kaiser Foundation executive who served on the panel.

But others, including state Sen. Herschel Rosenthal, D-Van Nuys, said the task force failed to address key questions, including whether to allow malpractice suits against health plans when they wrongly refuse care to patients.

In addition, Rosenthal noted that the panel called for creating a new entity to replace the Department of Corporations as the chief regulator of managed-care plans but never agreed how such an agency would be structured.

``Who's in charge? It's just going to be in limbo,'' Rosenthal said.

He also claimed that the panel, with most of its members appointed by Wilson, was stacked in favor of the managed-care industry.

But Chairman Alain Enthoven shrugged off such claims, though he acknowledged he has a long track record as an advocate for managed competition in the health field.

``You want to pick a chairman that doesn't know anything about it?'' he asked.

Once only a small part of the state's health care system, managed-care plans now dominate the field.

A survey conducted for the task force found that while most people are satisfied with their insurance plan, 42 percent had problems with their insurance plan in the past 12 months.

The largest share of those who reported problems said their primary complaint was trouble getting care. Ten percent said doctors or administrators were insensitive to patient needs, while 8 percent reported delays in receiving care or being referred to a specialist, the survey found.

But some panel members said they spent too much time looking at survey results and too little at the costs of proposed reforms.

``My biggest disappointment is we don't have a cost analysis,'' said Allan Zaremberg, executive vice president of the California Chamber of Commerce. ``There's no question when health insurance costs go up, certain small businesses look to drop their coverage.''

Managed-care officials also gave the panel's work mixed reviews.

On the plus, the industry supports consolidating HMO oversight into a single state body, said California Association of Health Plans Executive Director Myra Snyder.

But she called attempts to ``micromanage'' HMOs unfair.

``We had hoped for some systemic changes, for the panel to look at the state's health care delivery system, not the operations of individual plans, not at the micromanagement level,'' she said.

Officials for Kaiser Permanente, meanwhile, said they would enact nearly all of the panel's recommendations regarding dispute resolution. Kaiser was criticized by the state Supreme Court last summer, which found it had manipulated its arbitration system against patients.

Daily News Staff Writer Ben Sullivan contributed to this story.