Does your plan promote quality care?
Survey reveals impact of plans on physician care
The best managed care plans achieve a successful balance between cost management and physician autonomy in clinical decision making, according to physicians responding to the first national study of physician satisfaction with health plans.
On average, managed care plans scored lower than fee-for-service plans. However, several managed care plans scored above their fee-for-service counterparts, indicating that its not necessarily the managed care model that causes concern, but how the model is implemented by individual plans.
"Physicians are concerned, and rightly so, about health plan policies and guidelines that may negatively impact the physician's ability to deliver high quality care to his or her patients," says Dennis Becker, senior vice president of the MEDSTAT Group in Ann Arbor, MI.
Dissatisfied doctors
In 1997, the MEDSTAT Quality Catalyst Program surveyed nearly 9,000 physicians in six major metropolitan areas nationwide about virtually every aspect of their relationship with the health plans they work with, including the following:
o their satisfaction with the overall plan;
o their satisfaction with the administrative aspects of the plan;
o their perceptions of any plan-imposed guidelines for practicing medicine;
o the impact of the plan's policies and procedures for managing care and on physicians' ability to deliver high-quality care to patients.
The study found that physicians' dissatisfaction with their ability to provide quality care is a major factor in the choice to remove that plan from their practice. Nearly 50% of physicians who indicated they were "dissatisfied" or "very dissatisfied" with their ability to deliver high-quality care to the patients in a particular health plan said they had decided to remove that plan from their practice.
By comparison, fewer than 35% of physicians indicated their dissatisfaction with reimbursement or with administrative requirements would cause them to remove a health plan from their practice.
The survey found that three areas of plan performance have the strongest impact on overall physician satisfaction, both with plans and on their intention to recommend the plans to other physicians or patients.
Those areas of performance are:
1. limits imposed by the plan on care the physician can provide to patients;
2. impact of the plan's policies and procedures on the physicians' ability to deliver high-quality care to patients;
3. administration of the plan.
The most often reported administrative trouble was the physicians' ability to get help with appeals for denied claims. More than 32% of physicians indicated getting such help was a "major hassle."
In May, the MEDSTAT Quality Catalyst program expanded to include roughly 40,000 physicians who will rate 200 health plans in 20 major American metropolitan areas. Results of the 1998 survey will be available in the fall.
[Editor's note:For additional information on the 1997 or 1998 surveys or to purchase copies of the 1997 report, contact Andree Joyaux at (734) 913-3295. Reports are available for each market surveyed, and costs vary depending on the number of markets requested.]
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