MINNESOTA: TWIN CITIES' FRIENDLY PLANS

Need to see a doctor? All too often, you can only pick one you know nothing about from a list supplied by your employer's managed-care plan. But if you happen to work for one of 24 large corporations in the Minneapolis-St. Paul area, you could visit a kiosk near your office, punch a button and see a computer screen light up with a sales pitch like this, from pediatrician Leonard Snellman III:

"Smiles from children are the gas that keeps me going. Thus I wear funny ties, watches and socks, hide finger puppets in my desk drawers and try to have other diversions in my rooms so patients won't be too anxious...I have special interests in asthma, infectious diseases, preventive medicine and high-risk newborns."

Not quite what you need? Punch the button again. Other physicians--about 7,000 in 23 practice groups--also want your business. Some groups offer 24-hour hot lines and evening clinics for two-worker families. Some also trumpet their expertise in treating particular illnesses. "No. 1 in cardiac care," brags HealthSystem Minnesota--plus "96% early detection of breast cancer...above-average five-year prostate cancer survival rates." Some groups ask for $10 a month, in addition to the $70 payment each patient gets from his or her employer; others demand $20, still others $40 (no deductibles though). You pays your money--along with funds kicked in by such employers as Pillsbury, General Mills, Honeywell or Scotch tape-maker 3M--and you takes your choice.

Choice Plus, as the plan is called, is a good example of both what employers can do if they want to and why they should want to. It may not be the wave of the future in U.S. medical care, but it is one of the more imaginative alternatives out there for health-maintenance organizations.

Oddly, Choice Plus was not created in reaction to any bitter consumer backlash. Minnesota law requires all managed-care plans to be nonprofit, so there was no suspicion that patients were being shortchanged for the benefit of Wall Street. And 87% of the state's citizens tell pollsters they are satisfied with their medical care. But workers did grumble about cumbersome approval procedures, the need to change physicians whenever companies changed medical plans, and limited choices.

Executives, meanwhile, feared they would lose control of health-care costs. In Minnesota as elsewhere, HMOs are merging at such a pace that some analysts think the three that currently have 78% of the business will soon have all of it. They "would own all the doctors and hospitals and could charge us whatever they wanted," says a company official. Well before things got to that pass, companies' premium bills were rising rapidly, and no one could quite explain why. "We were writing checks into a system where we didn't know what we were getting for services in return," says Fred Hamacher, vice president of compensation and benefits for the Dayton Hudson department-store chain--though he did suspect that "there was a lot of administrative gobbledygook that added no value to the system, just cost." Like Harry and Louise of the TV commercials, Minneapolis executives thought there must be a better way.