Modern Physician recently sat down with Arthur Leibowitz, M.D., Aetna U.S. Healthcare's chief medical officer, to discuss problems providers say they have had with the insurer.
Can you comment on the bad publicity Aetna U.S. Healthcare has received in recent months, and on the perception among providers that it is not physician-friendly?
We're certainly in a very high-profile situation, and in many regards we've become a lightning rod for a lot of the things that are going on in medicine and managed care. . . . I think that in many regards, we've been unfairly portrayed. . . . The network continues to grow, and every day we sign new agreements with additional hospitals (and) doctors.
How is Aetna reaching out to physicians to repair some of the damage done in recent years?
The single, biggest way that we change the perception of the company is by putting ourselves in a position where we interface directly and personally with providers. . . .
Over the course of the last year and a half, there's been a tremendous redoubling of the effort to put our people on the street, in physician offices, in contact with doctors to try to create that personal kind of relationship. . . .
We've added to the point where we now have 125 full-time (regional) medical directors in the organization. We've got a staff of almost 500 provider relations people who are working in every market. . . . We have an ongoing dialogue with the (American Medical Association). The AMA (has) a very physician-centric orientation and from that orientation moves to look at patient-related issues. We take a view that's much more consumer-directed because our product is purchased at the employer and employee level.
Many of the physicians who have left the network cite the all-product contract as the reason for their defection. What is Aetna's commitment to the all-product contract?
We want to sign a contract with a doctor that brings the doctor into a relationship with our company and not into a relationship with the individual plans we sell. . . . The reason for it is we see the clear migration of people from one product to another along the continuum of managed care. We see indemnity members one year becoming PPO members the next. We see PPO members becoming point-of-service members and point-of-service becoming HMO. . . .
The individual employee has very little control over that, and we don't think that because the employer does something, such as change your benefit design, you should have to change your doctor. So we think of this as a doctor-friendly thing, but we certainly think it's a consumer-oriented approach.
What are some of the changes Aetna has made to the all-product contract to accommodate providers' concerns?
As a new physician, you join our plan understanding the nature of what we want you to do: sign the all-product contract. . . . The difficulty is dealing with people who already had a relationship (with Aetna or one of the health plans it merged with and) are not in all the products. . . . How do we transition them into a relationship in which the contract says they'll be in all products? So we've come up with a number of very flexible strategies to accomplish that. We think that the majority of physicians, if not all of them, would want to continue to care for their patients regardless of whether their patient changed plans tomorrow.
What we did was make an exception to our usual rule that physicians will be open to so many new members in the HMO. (We allow doctors) to care for their own patients if they change to the HMO model as a way of dealing with physicians whose obvious objection is joining the HMO. That's hit a positive chord in the marketplace.
Why do you say Aetna is one of the less intrusive health plans?
We feel if we connect a patient to a primary-care physician, and then connect a primary-care physician to the system, if (that) doctor says you need to see a dermatologist, who are we to say no? So there is no barrier that this plan places on the physician's ability to refer the patient for additional services.
Do you have any thoughts on physician unions?
A unionization approach is directed at an independent group of doctors to move them away to affiliate together for bargaining purposes. But the physicians have found that they don't need to stay independent if that's what they want to do. They can affiliate with a larger entity that can work directly with the payers and not have to create the structure of a union. (They can) join an IPA and associate with a hospital system or a large medical group. That's really what we're seeing, and I think that's the direction that we're going.