UnitedHealth Group's decision to unlock one set of handcuffs from physicians by removing most preapproval requirements drew praise from medical trade groups and even President Clinton.
But the surprise nature of the announcement and the attention it attracted may overshadow the impact of the decision.
For starters, other insurers aren't clamoring to jump on the autonomy bandwagon just yet, while some contend they already have loosened restrictions.
It's also unclear what insulation--if any--this decision will provide against class action suits or patient protection legislation being discussed in Congress.
The Minneapolis-based health insurer said it would no longer require physicians to get approval before treating patients. The medical decisions will be left to doctors, although the insurer still plans to review physicians' care patterns.
United also plans to show physicians where the company believes care can be improved and how patients could benefit, such as having heart patients take aspirin or ACE inhibitors.
The company said it would continue to require preauthorization for psychiatric treatment.
The nation's second-largest insurer, with 14.5 million enrollees, said it was spending more than $100 million a year in paperwork and administration costs to require physicians to ask permission for patient treatment that was approved more than 99 percent of the time. United representatives didn't return phone calls seeking comment.
Patients viewed the preapproval requirement as an infringement on their right to choose, and physicians deemed it an insulting second-guess. The American Medical Association praised the move, as did President Clinton. "Good for them. I applaud them," Clinton told the Associated Press. He added that perhaps the move might be able to correct what he views as problems in the healthcare industry.
"They're large enough that they might really be able to do it and have an impact on this."
Given the pummeling that managed care has taken, industry analysts said the action is long overdue.
"The important point is why is this even news," says Peter Boland, president of Boland Healthcare, a Berkeley, Calif.-based management consulting firm. "It's a 'duh' type decision. It's an acknowledgement of who's in charge of patient care. "
HMOs are going to have to work to treat physicians as true business partners, Boland says. Other insurers likely will adopt similar policies, he says.
"United's not going to be the only one," he says. "This is the crack in the dike. . . . It just makes good business sense."
But other insurers aren't likely to fall in line with United's announcement.
"My guess is that nobody's going to jump in and follow suit," says Don Timmerman, M.D., president-elect of the Connecticut State Medical Society.
Insurers are "sort of incredulous" that United would change one of the "basic tenets of managed care, which is to control and command physicians' decisions about patient care," Timmerman says.
United isn't a major player in the Connecticut market, which is home to Aetna.
Timmerman says the insurers with whom he has spoken aren't taking United's decision too seriously. "I think they're not too happy about (United) breaking the first commandment."
Comments by many health plan executives stressed the choices they are already give their enrollees.
Arthur Leibowitz, M.D., chief medical officer for Aetna, the nation's largest plan, says that choice is a "critical element" in the healthcare system. Aetna officials say they have developed several directives to improve quality of care.
Aetna executives declined to comment on the specifics of United's decision, saying they didn't have any details of the plan.
In its statement, Cigna HealthCare says that its goal is to ensure ready access to "quality affordable care for our members."
The Blue Cross and Blue Shield Association calls United's decision "evolutionary, not revolutionary." The company says that Blues plans around the country have operated in similar ways for years.
Susan Pisano, vice president of communications for the American Association of Health Plans, says that despite the initial lull, more health plans are likely to make changes. Others already have. "It's definitely the edge of a new wave of change," she says.
"I think if you look at the way managed care is changing and evolving . . . a lot of plans are looking for how a physician's overall practice patterns stand up to a performance standard. I think that United and other companies are hoping that this will be preferable to physicians and patients."
The move may provide some insulation from certain types of lawsuits, but not the kinds that have been filed thus far, says Barbara Mayers, a partner with McDermott, Will & Emery law firm in Chicago.
Aetna and Humana were slapped with suits centering on racketeering and failure to disclose terms and conditions of coverage, she says.
"One could say that in terms of past activity, it doesn't change anything," she says. "United may be vulnerable to that. Does it say that they're less vulnerable in the future? Perhaps."
It's not a straight line from making changes to protection from lawsuits, Mayers says. "None of this is clear cut . . . I think that it also may help in undercutting malpractice," she says.
Timmerman says one of the short-term effects is giving "physicians some of their dignity back. It also offers an opportunity for dialogue."
Boland says, "It's a very positive step to restoring some basic trust between the physician and the health plan."
UnitedHealthcare at a glance
Source: UnitedHealth Group