The current HMO's are in name only. Does anyone remember Harvard Community Health Plan, before it became Harvard Pilgrim? That was a real HMO. You paid their fee and everything was covered. It was offered by my employer, but at first I had to pay a few dollars a month myself. Eventually the cost of the indemnity plan increased so much that HCHP became a no cost option. There was one 800 number for everything. Instead of 911, you could dial the 800 number and everything was taken care of -- the ambulance, the hospital, the doctors, the labs -- they did it all. When I slipped on ice and broke my ankle, I got the best of care and it was wonderful.

I rarely take the time to comment on editorials. One only needs to see the venomous, partisan comments listed page after page to tune it out. That said, it seems as if this attack on PPO's instead of HMO's is largely based on one CEO's disgruntlement with not being one of the "big players" at the table. As a consumer, I have enrolled in both HMOs and PPOs. Given the choice based on my employer's purchasing power, I will chose a PPO every time. Why choose a PPO? Because it gives me the choice over the providers I will see. It streamlines the medical process, avoiding redundant doctor's visits, insufficient treatments that a general practitioner can recommend before seeing a specialist, and other difficulties in navigating the medical system. HMOs may be called more efficient. What they really do is shift the practice – and profits – of medicine from specialists to generalists. This may benefit the industry. But it unnecessarily burdens the patient.

I don't think there's much difference from the patient's viewpoint between a PPO and an HMO plan. You have to choose a doctor from a list of those available under either plan. The major convenience of an HMO is that all your other medical needs are covered by an HMO plan without any kind of claim nonsense. And I don't know how you can say an HMO generates redundant doctor's visits. That never happens to me. If I need a referral to a specialist, I can simply make a phone call to my doctor's office, or I can see the specialist and he'll make the referral request himself. Maybe you prefer PPO's, but I can't follow your claim that they're less expensive.

If Tufts cares so much about patients, why then did it try, during the last contract negotiaitons, to make all Tufts nurses get all of their health care at Tufts Medical Center. Imagine you are a nurse who lives in Southern New Hampshire and your toddler has an earache, and you have to drive all the way to Boston with your crying, hurting child to see your pediatrician, rather than your local pediatrician who takes Tufts insurance. Spare me the false concern, Mr. Beyer.

"I believe that physicians and hospitals should be rewarded for providing high-quality and efficient care" – My Byer if you think that 50 or so easily gamed indicators actually define quality in health care you are either a fool or being dishonest. ------------------------------------------------------------------------------------------ "Those plans also provide infrastructure investments to support the information systems and analytic capabilities providers" –What you meant to say was to support the effort to target your information systems on the extremely limited quality indicators used in supposed AQC. It doesn't mean that you are actually providing "quality" care. ------------------------------------------------------------------------------------------- "The AQC model has been touted by Blue Cross " – Anything that is touted by an insurance company should be suspect. The insurance industry is a parasite that doesn't add anything to patient care. They are only concerned about their own survival. ------------------------------------------------------------------------------------------- "This migration from performance-driven to preferred provider organizations — from HMOs to PPOs in health care speak" - No Mr Byer the public ifs fleeing HMOs because they are a horrible way for people to receive care. If you need to see a specialist and your HMO doesn't have enough to meet the demand you wait sometimes in pain while your condition worsens. If you your HMO doesn't have providers that will deliver specialized services, too bad you will just have to accept 2nd rate care. Apparently you want to force people back into these plans whether they like it or not. ------------------------------------------------------------------------------------------- Mr Byer capitation and managed care failed in the 90s. The public hated them. The state gave them new names (global payments and ACOs) and is trying to bring them back. Mr Byer is an insurance executive turned hospital administrator. He is not a health care professional and like moist administrators knows little about actual patient care. What I really see here is the CEO of a smaller hospital trying to force people to go to it. What he should be doing is finding specialties that Tufts can become very good at, as New England Baptist has done, rather than trying to get the state to force people to go their facility

Really. My daughter broke her wrist her wrist sledding when we were part of HCHP. We were seen by a PA rather than an MD and waited hours while they tried to find the supplies to cast it. Fortunately it was 12/31 and we went on a BCBS PPO the next day so we were able to get properly casted in the ER on 1/1.

How long ago was that? HCHP (as opposed to HPHC) has been gone for around 20 years or so. All doctor appointments took place in one of their handful of health centers, the largest at Kenmore. In the Boston area someone with a broken wrist would have been sent to Brigham and Womens Hospital, which was HCHP's hospital of choice. That's what happened with me broken ankle. HCHP was very highly rated before the Pilgrim merger that destroyed it, so I'm very suspicious of your horror story. In any case, if you didn't like it, moving on was the way to go. Most patients were more than satisfied.

Now I understand. You're a ranting hate monger. No reasonable approach from you, just vitriol. What a joke.

I am sorry "who cares" but you really don't know what you are talking about or maybe you are just a sock puppet working for Tufts or the insurance industry. --------------------------------------------------------------------------------------- In case you actually exist I will explain. I have been a civilian health care provider for over 30 years. I watched mangled care raise havoc in the 90s. I watched good hospitals close and patients thrown out of hospitals sick and too quick. Did you know we have the shortest hospital stays in the developed world? Probably not as you don't know much about health care. I have seen infection rates rise as nurses were replaced by people off of the street with a few weeks training. Ever wonder why you wait so long in the ER for a bed in the hospital? The lingering effects of mangled care and capitation. I have seen patients die due to errors caused by hospitals changing drug vendors weekly to get the lowest price with different packaging combine with understaffing. I left mangled care because I was tired of seeing a never-ending procession of different doctors and third rate specialists that would work for what the HMO was paying. I have seen the damage that empty suit non-healthcare professional hospital administrators have done to patient care. So don't tell me about how wonderful mangled care is I lived through the damage it caused. --------------------------------------------------------------------------------------- Oh, HCHP only sent you to BWH if you were in the city. In the suburbs they attempted to mange it within the health center (cheaper for them bad for the patient – capitation and mangled care in action again. The incident I described did happen under HCHP not HPHP.