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Read Making a Killing

home / healthcare / in the media

Sacramento Bee
Jun 19, 2000

by Jeanne Fisher

HMO Czar's Bedside Manner Lauded

The state's new HMO czar hasn't levied a single fine or issued even one formal recommendation yet, but the health plans he'll regulate and other managed care stakeholders have already passed judgment: They like him.

Of course the new guy, Daniel Zingale, is easy to like now. All he's done so far is talk.

When Zingale, 40, officially takes over the new Department of Managed Care on July 1, the industry will be watching closely to see how the man charged with, among other things, making sure health plans take their medicine will administer the dose.

So far, the indication is that Zingale's style will be more Mary Poppins than Nurse Ratched.

Consider: In making his unofficial debut before managed-care industry leaders this spring at the annual meeting of the California Association of Health Plans, Zingale gave an informal talk that at times bordered on stand-up comedy.

During the talk, the new regulator ran his fingers over his barely-there clippered hair and joked that the hair-replacement drug Rogaine would henceforth be deemed "medically necessary" treatment.

But Zingale, who stepped down as head of the nation's most powerful AIDS lobby to take the job, also made it plain to the industry representatives that he sees himself first as a patient advocate. He vowed to come down hard on the plans when they don't do right by their members.

"We will act with a quicker wrist and a sharper scalpel when you don't put patients first," he told the plans.

The message came through loud and clear, said Walter Zelman, president of the health plans association.

"No one has any illusions about whose side he's going to be on ultimately," Zelman said. "No one is expecting he will be a weak or pro-plan regulator. What the plans worry about is a regulator who's capricious, and Zingale has shown us that he intends to take a fair, balanced and consistent approach."

Zingale, who was appointed to his new post by his friend and former boss, Gov. Gray Davis, sees himself as a troubleshooter and communicator and describes the department as a kind of "control tower for the industry."

The focus of the department will be to head off problems before they occur -- a strategy he calls "preventive regulation."

"It's always a delicate intervention when government tries to assist the private sector," said Zingale, who first worked for then-Assemblyman Davis and later joined state Controller Davis' team as chief of staff. "What we want to do is be helpful without getting in the way."

Despite Zingale's talk of collaboration and common-sense regulation, managed care companies have good reason to feel apprehensive of the new regime, which will take over regulation of their industry from the state Department of Corporations.

The new department, created as part of last year's sweeping HMO reform package, will have twice the staff, as much as three times the money of its predecessor and a mandate to restore public confidence in managed care at a time when the industry is under attack from patients and providers alike.

Zingale is in the unenviable position of having to invent his department -- the first state agency to focus its attention solely on managed care -- even as it tackles a formidable workload.

The department will begin by:

* Enforcing -- and educating consumers about -- two dozen new managed care laws that took effect Jan. 1, including the creation of a third-party review system where consumers can get grievances heard and resolved.

* Staffing and convening three new advisory boards that will advise the department on managed care in general, as well as medical matters, legal issues and health plan and provider financial solvency.

* Bringing online a consumer resources and legal review center, including a call center, to assist consumers with managed-care questions and problems.

* Launching a statewide education and awareness campaign to let Californians know it exists.

"It's an abominable task," Assemblyman Martin Gallegos, the Baldwin Park Democrat who authored the bill that created the department. "He's basically got to start from scratch."

Yet Zingale lobbied hard to get Davis, whom he describes as a friend and mentor, to give him the job, which attracted Zingale as "an incredible challenge and a once-in-a-lifetime opportunity."

"I'm a little awed by the magnitude of what we're doing," said Zingale. "But I have an enormous amount of faith in the governor's judgment. His thinking I am up to the job means a lot."

Taking the job also meant returning home to Sacramento, where Zingale was born and raised, after more than a decade working in Washington D.C., most recently as director of the advocacy group AIDS Action. He lives in Land Park with his partner, Chuck Supple, and their 5-year-old son.

Many are optimistic that Zingale and the new department will lend a credibility to the state's regulation of managed care that had been lacking in the past.

"The Department of Corporations was all too often an invisible regulator," said Peter Lee, a longtime health consumer advocate. "I'm optimistic that Daniel will put an end to the era of invisibility."

At the same time, Zingale's not looking for an "I gotcha" approach to regulation, Lee said.

"My sense is that he's much more oriented toward collaborative, constructive approaches, which I think makes more sense in the long term," he said.

Then there are those who think the department needs to come out swinging.

Jamie Court, one of the state's sharpest critics of managed care, thinks the new regulator needs "a little more temerity and a little less timidity."

"The department needs to be a strong cop on a tough beat," said Court, who last year penned an indictment of the managed care industry titled, "Making a Killing." "It needs to start banging heads and issuing fines."

Whatever direction the new department takes, it looks as though it will have the staunch support of the Legislature behind it.

Zingale last month went before the Assembly Budget Committee to defend his $27.5 million budget request for the coming year and came away with everything he asked for, plus an additional $15 million. A conference committee since has trimmed the additional money -- intended to bankroll a massive education campaign announcing the new department -- to $5 million.

"If we don't provide the department with the resources it needs, the people of California won't benefit from the legislative intent, which was to have a more responsive, active regulator and to restore public faith in managed care," Gallegos said.

GRAPHIC: Bee photograph / Owen Brewer
Danial Zingale conducts an imformal staff meeting before officially taking over the new Department of Managed Care on July 1. "What we want to do is be helpful without getting in the way," he says.



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