HMO group pledges friendlier times ahead
Providers wonder if coalition proposal is for real
The CEOs of 22 managed care plans have formed a coalition that is promising to address and correct a laundry list of long-time complaints from physicians about the shabby treatment they receive from HMOs.
Among the items those HMOs have promised to address are ways to reduce the number of claims denied by plans, standardize physician credentialing requirements, simplify administrative procedures by moving much of the present paperwork onto the Internet.
Calling itself the Coalition for Affordable Quality Healthcare (www.caqh.org), the group is comprised of CEOs from such powerhouse plans such as Aetna, Cigna, Humana, PacifiCare, and several Blues. However, HMO heavyweights as UnitedHealth Group and Kaiser Permanente are not currently participating.
"We want to and need to improve relations with our physicians. They are the people we rely on the most to improve the health care system," says Leonard Schaeffer, CEO of WellPoint Health Networks and chairman of the group.
One reason those HMOs are extending an olive branch to providers is that rate hikes are running 8% to 10%, and increased competition from other managed care organizations such as PPOs and IPAs are starting to cost them business. In fact, for the first time in its history, the HMO industry’s membership base is actually shrinking, reports InterStudy, a Minneapolis-based consulting firm.
Then, there’s legislation in Congress, combined with activities at the state level, which could mean patients will soon be able to sue their HMO for malpractice, which makes managed care companies nervous.
The check’s in the mail
That might seem like a dream come true to many physicians frustrated with dealings with managed care companies. In fact, many experts say that’s just what this is — a dream.
"These commitments seem to be simply more rhetoric," observes Catherine Cohen, vice president of governmental affairs at the American Academy of Ophthalmology. "The actions of the industry over the past half decade have shown that they do not want change for the good of patients."
HMOs do know they have major trust issues with both physicians and the public, which
could spell disaster if not corrected. In a July 18 announcement, the coalition said it was developing a list of possible projects that would be unveiled every six months, along with progress reports.
One project under consideration, for instance, is to standardize the various claim forms and billing processes among HMOs. Another is to expand a pilot project by Foundation Health Systems in Woodland Hills, CA, with a 50-member group practice in Fairfield County, CT, intended to reduce claim rejections by increasing access
to membership data.
Under that model, HMOs have created a Web site with real-time information on member eligibility and other changes. Providers have 24-hour access to the information. Using the system, the foundation says it has been able to reduce the number of claims filed by the participating group from 450 a month to about 15 a month.
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