Texas' embrace of cowboys and football doesn't make it seem the most peaceful place on earth. However, the Dallas-Forth Worth Business Group on Health wants to give peace a chance.
The group is conducting a series of roundtable discussions, which it hopes will smooth the sometimes tense relationships between health plans and medical groups. The group represents some 140 employers, including such corporate giants as American Airlines, Bell Helicopter, Exxon, J.C. Penney Co., Lockheed Martin Corp. and Southwest Airlines.
Employer coalitions don't usually play a diplomatic role in the continuing skirmishes between physicians and health plans. But given the deteriorating relationships between health plans and doctors, the Dallas-Fort Worth coalition had little choice, says Marianne Fazen, its executive director. She says the conflicts may even compromise the quality of patient care, and quality issues primarily drive the group.
"We're going to be a little Switzerland and try and open up collaborative and corrective actions for issues they're able to work on," she says.
The coalition will conduct five roundtable sessions between this month and April to try to identify issues that physicians and health plans are willing to address and develop a plan for resolving them. Pharmaceutical manufacturer Pfizer is underwriting the seminars with an educational grant.
The first roundtable, held last week, identified three concerns the two sides would like to resolve. The next three sessions will be used to formulate a plan of action to address those concerns. The final session next spring will focus on accountability; participants will review their progress toward solving the specific problems and evaluate the effectiveness of the discussions.
"The Dallas-Fort Worth area is a flashpoint for tensions between physicians and health plans," says Helen Darling, a healthcare consultant with Watson Wyatt Worldwide and a facilitator for the first session. "There's no other place in the country with more reason to resolve conflicts."
Strained relations between providers and health plans are common, particularly in areas with sizable managed-care penetration. But the healthcare debate has been politicized more in Texas than in other parts of the country.
For example, physician lobbyists helped win an antitrust ruling requiring Aetna to divest many of its assets in the Dallas area so that it could proceed with its recent acquisition of Prudential HealthCare.
Strong physician backing also helped the recent passage of state bills allowing patients to sue their health plans and doctors to unionize. While physician lobbies insist such activism is necessary to enable them to provide care, they also acknowledge it does not endear them to the health plans with which they contract.
"It's all exacerbated a legitimate debate about the power of health plans vs. the ability of physicians to provide care," says Kim Ross, vice president of public policy for the Texas Medical Association, which staunchly supported both pieces of legislation.
Debate aside, Fazen and others are concerned that the deterioration of doctor-health plan relationships is causing a deterioration in the quality of healthcare that coalition members are receiving.
"It's clear the breakdown in relations is contributing to a significant quality gap for area patients," says Denise Lynn, managing director of benefits for Dallas-based American Airlines and coalition president.
Ross agreed that healthcare quality may be at risk.
"With fierce predatory competition among plans and employers' purchasing based on price, sooner or later quality standards for patients will erode," Ross says.
However, to back up such claims, there's little more than anecdotal evidence-mostly in the form of increased complaints Fazen says she has received from her members.
Fazen did cite recent data from the National Committee for Quality Assurance's Health Plan Employer Data and Information Set, or HEDIS. The data show that HMOs in the Dallas area scored below average in such preventive-care categories as breast and cervical cancer screenings, eye exams for diabetics, antidepressant medication management and child immunizations.
However, Fazen couldn't directly link the low scores with deteriorating payer-provider relationships. And the HEDIS scores reflect regional averages; aside from Dallas, the region includes the rest of Texas, Arkansas, Louisiana, New Mexico and Oklahoma.
Yet despite the lack of a direct link between provider-payer relations and the quality of care, the roundtables have drawn strong support from the payer and provider communities. Fazen says that the chief executive officers of virtually every Dallas HMO and Jerry Patterson, executive director of the Texas Association of Health Plans, plan to attend all the sessions.
"It's a very good idea," Patterson says. However, he stopped short of agreeing with Fazen that healthcare quality is deteriorating and added that not all doctors and health plans are at one another's throats. "Some (plans) do a better job with their relationships with physicians than others," he says.
The roundtable series is also catching the attention of other purchaser coalitions. Fazen says she has heard from three other coalitions interested in patching the rifts in their local provider and payer relations.
"We're hoping ours can be a model for coalitions across the country," she says.