EXECUTIVE BRIEFINGS
December 1, 1998 4 minutes read
EXECUTIVE BRIEFINGS
Aetna revamps physician contracts
Blue Bell, PA-based Aetna U.S. Healthcare is altering its contracts with about 300,000 physicians following complaints from the Chicago-based American Medical Association (AMA) that its contracts contained provisions that were potentially harmful to consumers, the Wall Street Journal reports.
The new contracts contain language encouraging physicians to talk with patients about all pertinent information to their care, as well as how Aetna U.S. Healthcare reimburses its contracted physicians. In addition, the contracts have dropped wording the insurer claimed shared ownership of medical records with doctors.
The Journal quotes an Aetna U.S. Healthcare official that the new language in the contract does not reflect a change in policy, but instead reflects an effort "to bend over backwards to eliminate the possibility that anyone could misconstrue the agreements."
More health plans withholding NCQA data
The number of health plans refusing to allow the Washington, DC-based National Committee for Quality Assurance (NCQA) to release data on 50 performance measures rose sharply in 1998, Knight-Ridder/Tribune News reports.
Nationwide, 292 health plans reported data measured as part of the Health Employer Data Information Set (HEDIS), the article states.
HEDIS measures are used to measure health plan performance in a variety of areas — such as vaccination rates for patients younger than 2 years old, and mammogram screening rates among health plan members. About 155 other plans gave data to NCQA, but would not allow the information to be released. That number compares with 41 plans that did not want their data released for public consumption last year.
Typically, those withholding their data performed worst on almost every measure than plans that allowed their data to be released, the article states.
Florida Blues to purchase Principal
Jacksonville, FL-based Blue Cross and Blue Shield of Florida announced plans to purchase Principal Health Care of Florida, according to the Knight Ridder Tribune Business News.
The deal involves only the Principal HMO, according to the Tribune Business News.
If regulators approve the deal, Principal’s HMO members will be switched to Blue Cross and Blue Shield’s Health Options subsidiary after March 1.
Once Principal’s HMO members are added to its ranks, Blue Cross and Blue Shield will have nearly 888,000 HMO participants in Florida.
California MDs file claim against insurers
The California Medical Association has filed a petition with the state’s Department of Corporations charging that many health plan contracts fail to state how much contract physicians be paid and allow health plans to make medical decisions, according to the Knight Ridder Tribune Business News.
The complaint also states that many health plan contracts leave liability with the physician for those decisions and give payers inappropriate control of patient records.
The Department of Corporations oversees most managed health care plans.
The article quotes California Medical Association President Jack Lewin, MD as saying unfair or illegal contract provisions allow HMOs to escape their own accountability for medical treatment decisions.
Collaborative will seek to spark best practices
Targets purchasers, consumers, providers
A new national collaborative seeks to spark grass-roots support for quality improvement by promoting best practices even beyond the health care community to purchasers and consumers.
The National Coalition on Health Care in Washington, DC, has teamed up with the Institute for Healthcare Improvement in Boston to launch Accelerating Change Today — For America’s Health. The initiative will produce best practices reports and will use various methods, including the Internet, to spread the word.
How to spread the word?
"To a large degree, we felt that information wasn’t getting out there to providers, purchasers, and consumers," says Joel Miller, MSEd, director of policy for the coalition. "What was needed was an extra push to highlight this information and the success stories."
The coalition, founded in 1990 in the midst of the national health care reform debate, is composed of 90 organizations including corporations, medical groups, unions, consumer and religious organizations, and academic medical centers.
The initiative grew out of a report, As Good as It Should Get: Making Health Care Better in the New Millennium, commissioned by the coalition and written by Donald Berwick, MD, founder and president of the Institute for Healthcare Improvement in Boston.
Berwick cited examples of clinicians and hospitals that have improved care and saved money. But he notes that innovation and quality improvement at individual institutions doesn’t spread nationally.
"Not only do the particles of excellence lie lonely, unduplicated, and not spread, but not even one organization has yet had the ability, or perhaps the courage, to collect these many exciting innovations into a new whole," he says.
The coalition plans to release its first report in mid-1999, with a second report by the end of the year.
"We hope we will be releasing at least two reports per year," says Miller. "There will be complimentary activities surrounding those reports, such as shorter fact sheets and forums for the media and other groups to highlight the findings."
The coalition also plans to track the use of the reports, although it’s not yet clear how that will be done.
Editor’s note: For a copy of the report, contact the National Coalition on Health Care, 555 13th St. NW, Washington, DC 20004. Telephone: (202) 637-6830. World Wide Web: http://www.nchc.org.
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