Gina Latture, a group account executive with New York Life HealthPlus, was misidentified in a photo caption in the Business section in Sunday's editions of The Sun.
The Sun regrets the error.
Pat Hershan had heard bad things about health maintenance organizations. Her husband joined an HMO once and had been forced to switch from a doctor he knew to one he didn't. She'd never do that, not after years of building good relationships with her physicians.
Yet when her employer, Baltimore Gas and Electric Co., offered a new kind of HMO plan last year, she signed up -- and liked it so much she is re-enrolling for 1995.
Ms. Hershan is in a point-of-service plan, a unique combination of HMO and traditional insurance features that make it one of the hottest selling insurance policies in Maryland. More and more employers are offering it this fall, the season when most workers are asked to choose a health policy for the new year.
What makes the policy appealing to many people is it gives them the advantages of an HMO -- comprehensive services with no deductible and an office visit charge of only $5 or $10 -- and the right to see a doctor outside the HMO's own panel of physicians.
This calms patients' fears about losing freedom to choose doctors. HMOs control costs by requiring patients to pick one of the HMO's primary care doctors, or family physicians, who determine when the patient will see a specialist or obtain an expensive test.
"I have the best of both worlds," says Ms. Hershan, a 43-year-old secretary from Catonsville, citing the choice of doctors and low out-of-pocket costs of belonging to an HMO.
There is a downside to point-of-service plans. If you decide to see non-HMO doctors, you'll pay charges typical of a traditional insurance plan: an annual deductible, often $250, after which you'll pay 10 percent to 30 percent of medical bills, depending on the particular point-of-service plan.
But most workers stay within the HMO network of doctors, according to insurers and employers. "Once they get in they're pleased. They like the doctors and they stay in," says Elaine W. Johnston, director of benefits at BGE.
That was Ms. Hershan's reaction. All the doctors she and her husband were using for years are in the HMO network, making it unnecessary, thus far, to see a non-HMO physician.
As workers and their families get used to the HMO concept, their employers are more likely to convert point-of-service plans to less expensive HMO-only plans. For this reason, insurers refer to point-of-service plans as a "bridge" or "stepping stone" from traditional insurance policies to HMO-style "managed care."
"Many of us who buy health care for employees believe that managed care is an important way to control costs, and yet we recognize that many of our employees are reluctant to give up the total freedom of choice of providers," Ms. Johnston says. "The point-of-service plan gives them an opportunity to try managed care while knowing if they are not pleased at any point, they may go outside the network."
This year, BGE offered its first point-of-service plan, from Preferred Health Network, a Baltimore-based managed care company. Fewer than 5 percent of workers enrolled in it, which is not surprising for a new program. But now the company is replacing one of its expensive traditional plans with a second point-of-service plan, offered by Blue Cross and Blue Shield of Maryland.
Over time, Ms. Johnston hopes and expects that the percentage of workers in costly traditional plans -- now more than 60 percent -- will decline. Other employers share the same goal.
At the Rouse Co., the rising price of traditional plans is pushing workers into less costly HMOs and a relatively new point-of-service plan in which 7 percent of employees are enrolled. "My sense is there has been additional interest by people looking at the program for 1995," says William D. Boden, vice president and director of personnel and administrative services.
The savings can be enormous. The Black & Decker Corp. has saved at least $31 million from four years of employee use of a point-of-service plan, says Ray Brusca, vice president for benefits. Whereas once more than 80 percent of company workers were in a traditional health plan, today more than 90 percent are in point-of-service.
Before 1990 few companies offered a point-of-service plan. Now about 33 percent of Maryland employers do -- more than six times the national percentage, according to the Foster Higgins benefits consulting company.
Dennis J. Treat, a Foster Higgins executive, attributes the growth of point-of-service plans to the fact that Maryland is farther along the road to managed care than most states, with an estimated 26 percent of residents enrolled in HMOs.
Estimates of the number of Marylanders enrolled in point-of-service plans are rough, based on narrow survey samples, but Foster Higgins' best guess is 20 percent. There's no question that the percentage will climb.
"Point-of-service is the hot ticket right now," says Greg Conderacci, director of marketing for Prudential in Maryland. "Roughly half of Prudential's overall membership is in a point-of-service plan."
It's "probably the biggest trend out there," agrees Christopher Doherty, spokesman for HealthPlus, a New York Life HMO. At Mid Atlantic Medical Services Inc., communications manager Michael H. Savage reports that 46 percent of subscribers are in ** an HMO plan that permits them to select a non-HMO doctor.
Blue Cross and Blue Shield predicts "significant growth" in its point-of-service plans; CIGNA HealthCare estimates 25 percent annual growth. William F. Simmons, president of Group Benefit Services, says new health policy sales to mostly small businesses are split between point-of-service plans and preferred provider organizations -- physician networks from which subscribers pick their own family doctors and specialists.
Kaiser Permanente will offer its first point-of-service plan in January.
One of the biggest markets is state workers, who have a choice of three point-of-service plans in an options menu that includes conventional HMOs and preferred provider organizations.
Edna Crosby, a state Department of Education employee, listened closely to a Mid Atlantic representative describe his company's point-of-service plan at a recent "health fair" at which insurers promoted their programs.
"You have a lot more flexibility," the Mid Atlantic man said. "You can get care from any provider."
Ms. Crosby, who is in an HMO now, is considering it. "This is something new, the point-of-service, and I just have to look into it."