Doctors And Health Plans: Making The System Work
Special To The Times
I'M a physician, so I know precisely the importance of a great doctor-patient relationship. People get the care they need, when they need it. And they stay healthier. When you like your doctor and trust what he or she has to say, and they listen to your concerns and needs, it makes all the difference in the world.
I was 20 years in private practice in internal and pulmonary medicine. Now, I'm the medical director at Regence BlueShield, our state's leading health plan, with more than 1.1 million members.
So, when I heard some doctors - even those who are friends and longtime trusted colleagues of mine - characterizing a new contractual agreement we distributed last summer to providers in this state as a "master-slave relationship," well, that didn't sit too well with me.
I've worked with health plans my entire medical career; on occasion I have disagreed with them. But I was never their slave. And I was never told how to practice medicine. I would not tolerate that when I was in private practice, and I won't tolerate it as medical director at Regence BlueShield.
That's why when I felt the backlash from my colleagues last summer, my one and only reaction was this: We need to find a better way for doctors and health plans to work together. Period. We must have enough of a partnership to come together, with trust and credibility, to resolve those problems. That's what is best for our patients and health-plan members.
We listened to physician leaders from groups such as the Washington State Medical Association and the Pierce County Medical Society, as well as many individual providers and practitioners who had voiced their strong concerns about our newest contract. And then we got to work on making changes to our contract.
We went back to the physician leaders in our state and showed them the changes. Case in point: On several occasions, we met with the executive director and president of the Washington State Medical Association, the most vocal critic of our initial contract distributed last summer. They gave us input, were given comprehensive reviews of our revised contract, and given time for additional response and comment.
We've made the first move to the physician community in this state - taking the negative feedback from doctors on our new contract and going back to doctors for input and review. What's more, we are committed to this path.
Physicians in this state probably won't say our revised contract is perfect or that every word suits their purposes. And that's OK. But they will say it is a definite improvement and that we worked together, in good faith, to settle our differences.
So why, if we've learned to work better together, can't all physicians put an unqualified stamp of approval on this contract? This is a business contract and our responsibilities do differ. Physicians are responsible for the medical advice and care they provide to patients. Health plans are responsible for taking the premium dollars our members give us each month and ensuring that they are spent in the most efficient and effective manner possible. And we may have, at times, a difference of opinion with our providers over how those dollars are spent.
But the key will be how we settle our differences. At Regence BlueShield, we believe there is a middle ground that will allow us to work together on behalf of patients and members, even when the issues are complex and contentious. We know the issues are tough, and will only get tougher. We will go head-to-head with our physicians and other providers over how much we reimburse them for medical services, among other key issues. Because that's our responsibility - keeping costs reasonable while ensuring that health-care consumers have access to quality providers and medical services.
Early this year, physicians throughout our state will receive our new, revised contract, and we think they'll be pleased with the changes we've made. They'll know we've listened to their concerns and responded in a positive manner.
We believe we have started to lay a solid foundation of collaboration. Our actions over the latter part of 1998 in working closely with physicians in crafting a fair, responsible contract are a practical example of our future intentions.
We won't settle for "Us versus Them" anymore. I hope my colleagues feel the same way.
Donald D. Storey, M.D., is medical director at Regence BlueShield, and was a practicing physician for more than 20 years in Washington. He is also a board member of the Washington State Medical Association, the state's leading physician organization.
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