It looks as though thick-headed managed care executives finally are getting it.
They bashed doctors and squeezed patients for so long that the bad rap they earned made them almost as notorious as America's tobacco companies.
Despite the promise of more prevention and better coordination of care, the health plans have focused almost totally on cost to the detriment of quality, a tactic that has harmed patients. And the endless red tape has burdened and frustrated clinicians who are supposed to be their business partners.
A few savvy thinkers, however, realized that serious action was needed to improve their image and their operations-or they would face growing pressure for passage of a federal bill of rights and the wrath of state attorneys general who led the legal challenge against cigarette manufacturers.
At long last the light has dawned on leaders of top managed care companies. Aetna, the nation's largest health insurer, brought in a chairman and CEO from outside healthcare, William Donaldson, and he has wasted little time in working to regain the trust of physicians.
Donaldson and John Rowe, M.D., the company's new president, moved quickly to end the universally reviled "all-products" clause, which forced doctors who wanted Aetna's desirable PPO lines to also sign on for its lower-paying HMO products. This all or nothing option rankled physicians.
Still, the contract renewal process will drag this transition out for many months. Doctors are required to make a written request at least 90 days in advance to drop the clause. Aetna could speed up the process by providing their contractors with a telephone hot line and e-mail address to ease communication.
In California, HMO executives have promised to work with medical organizations to come up with actuarially sound capitation payments. This may be easier said than done, but at least it will convince physicians that someone is listening to their concerns, particularly if it results in a collegial evaluation of the marketplace pressures facing medical practices in the Golden State.
UnitedHealthcare, second in size to Aetna, won a public relations bonanza a year ago when it announced that it was eliminating preauthorization requirements. Again, the renewal process has slowed the implementation of the new policy. Additionally, the company faces minefields as it develops a profiling system that will allow it to scrutinize clinical decisions and drop physicians from their network if they don't practice an appropriate standard of care.
Despite their limitations, such innovative approaches are the only way that managed care companies will get back in the good graces of the public. And they make sense. After all, United's own data proved preauthorization was costing more than it was saving.
If health plans did nothing else, speeding up payment through electronic approval and reimbursement strategies would gain gobs of goodwill among physicians. But for now, managed care companies are making wise decisions to try to mend fences.