When the American Association of Health Plans (AAHP) fired off a memo to its members last month on the need for improving business practices to "meet the fundamental test of public understanding," the bold tone caught the national media's attention. The memo's admission that the industry's practices have caused much of managed care's backlash provided a compelling backdrop for discussing new consumer-friendly initiatives designed to improve health coverage.
The memo, somehow leaked to the media, was described as a "frank call to action," in a Dec. 29 article in USA Today. It came on the heels of United Health Group's recent and highly publicized announcement of a new policy to drop rules requiring doctors to get permission for tests, procedures and hospitalizations. Other "substantive changes" like efforts to eliminate physician gag clauses and streamlining the patient appeals process have all worked to engage the public in the positive adjustments being made to make HMOs more consumer-friendly, says Susan Pisano, AAHP's VP of corporate communications.
To build on this momentum of substantive change, health plans will need to promote their commitment to consumer satisfaction on the local level among the business community and advocacy organizations. In addition, the organization is pushing for health plans to do a better job of discussing the tangible steps they are taking to improve confidence in the managed care system and patient/physician concerns.
These recommendations should also help to boost health plan retention, which is primarily driven by customer relationships and problem resolution, according to a recent market research study, "Understanding the Cause of Disenrollment," by the HSM Group. The three factors that consistently influence voluntary disenrollment, according to the study, are:
- primary care physician attitudes toward patients;
- outcomes of specialty care; and
- the health plan's ability to solve member's customer service problems.
Physicians Aren't Convinced
Although HMOs are making exciting strides in becoming more consumer-friendly, they've yet to win over physicians as recent headlines suggest. Earlier this month PacifiCare rubbed some physicians in Denver the wrong way. The health plan issued a memo to physicians there with a controversial ultimatum: sign up or lose patients. The letters went to Aurora Associated Physicians and South Metro Physicians, two of the physicians groups that belong to Millennial, Colorado's physician alliance. Millennial has been involved in a contract dispute with PacifiCare. These physicians were given a Dec. 8 deadline to sign with PacifiCare or the health plan would notify patients that they would need to select another primary care physician. Physicians there are slamming PacifiCare, accusing the health plan of resorting to intimidation and using patients as pawns. This negative PR, comes on the heels of PacifiCare's announcement last month that it was expanding its independent review process, which allows members to appeal denied coverage decisions more quickly. The expedited process has been expanded for 2.7 million members in nine states.
PacifiCare may be getting praise from its members for this latest move, but if the health plan doesn't do a better job of winning over physicians it will remain behind the eight ball in gaining the kind of full public confidence in its business practices that the AAHP recommends.
(AAHP, Susan Pisano, 202/778-3245; HSM Group, 490/947-8078)