President’s letter: Advocacy in action: addressing health plan pain points

Friday, July 15, 2016 08:41 AM

by Michael Volz, MD President, Colorado Medical Society

Advocacy works. That is what I was thinking about as I walked into the first meeting in July of a special Physician Advisory Group convened by Colorado Division of Insurance Commissioner Marguerite Salazar charged with making recommendations to address some of the problems that physicians are facing with commercial health plans. If you are a regular reader of Colorado Medicine then you know that CMS has devoted a lot of time and energy to resolving these pain points and getting policymakers to hear what the current realities of doing business with health plans are like for physicians and patients. Commissioner Salazar listened.

We continue to listen. We have heard from you and physicians like you from across the state about problems doctors are facing, like unfair contracting, prior authorization, claims payment, delayed payment and network selection/de-selection. We have also heard from patients about their often exasperated and sometimes desperate need to have health insurance that actually works. That is why CMS designated payer issues as an organizational priority and why our advocacy on these issues has only just begun.

We are grateful that the Hickenlooper administration is both actively listening and engaging with us to not just better understand but to solve these problems. Division of Regulatory Agencies Executive Director Joe Neguse, Commissioner Salazar and Hickenlooper senior health policy advisor Kyle Brown, PhD, all participated in a physician listening session in April that featured first-hand experiences from almost 35 physicians from around our state, different settings and many specialties about what interacting with health plans is really like today. The meeting was particularly timely as the DOI is considering whether or not to block the Anthem-Cigna merger, in addition to wrapping up a stakeholder process to help develop new network adequacy regulations. The stories were candid, concerning and sometimes even heart wrenching. And as Commissioner Salazar said, the stories are troubling. As a result she created the Physician Advisory Group and her work and leadership now represents another important step in our fight to remove barriers to good care.

Now is the time
Marketplace changes, mega-mergers, sweeping national and state legislative and regulatory reforms are only intensifying the need to understand and solve these problems. We have always held that physician practices are one of the best barometers for how well the system is working to serve patients’ and communities’ needs. Right now physician workplace dissatisfaction is at an all-time high and continues to rise. It is well documented that much of this dissatisfaction is the direct result of third party interference resulting in the inability of physicians to provide good care. The fact is that if Colorado’s health insurance system was a patient, then she would need a doctor.

Will the new Physician Advisory Group be the prescription to cure all of these ails? No, of course it won’t. But it can serve as a critical next step in addressing key issues including network adequacy, provider directories, access plans, continuity of care, contracting/payment issues and prior authorization. Importantly, given all that she has heard recently from physicians, Commissioner Salazar has also expressed interest in exploring how the DOI could begin taking provider complaints rather than having to be exclusively reliant on consumer complaints in order to investigate and act upon inappropriate health plan behavior. In addition to myself, the group is comprised of some of the profession’s best minds from different specialties, practice types and settings including Drs. Christina Finlayson, David Friedenson, Davis Hurley, George Kalousek, Alan Kimura, Glen Madrid, David Markenson, and Peter Ricci.

Standing up
This is what advocacy is all about. Championing a just cause to solve a challenging and complex problem, using a thoughtful, methodical, evidence-based, professional and persistent process with input from our membership. As the summer heats up and campaigns begin the sprint toward November elections, I understand all too well that politics can sometimes appear maddeningly complex and frustratingly slow. I also know that your Colorado Medical Society is very good at advocacy. This is what we do – we stand up for our physician colleagues and the patients we serve. We are here for all of you. The new DOI Physician Advisory Group and our other work on payer issues is the latest demonstration of resolve in order to make a difference.