DOI listening session

Friday, May 20, 2016 10:44 AM

Physicians share realities of dealing with health plans

by Chet Seward, Senior Director Health Care Policy

DORA Executive Director Joe Neguse listens as Commissioner Marguerite Salazar reacts to physician stories regarding daily interactions with health insurance plans.

The Colorado Medical Society convened physician leaders from across the state in April to meet with Colorado Insurance Commissioner Marguerite Salazar; her boss, Division of Regulatory Affairs (DORA) Executive Director Joe Neguse; and Gov. John Hickenlooper’s health policy adviser Kyle Brown, PhD. The meeting provided these important policymakers with a chance to hear first-hand from physicians about what it is currently like to do business with health plans. There was no shortage of compelling stories.

Nearly 35 physicians from diverse specialties and practice settings ranging from huge multi-specialty urban groups to solo rural practices shared experiences and offered perspectives during the two-and-a-half-hour listening session. Topics included delayed payment, prior authorization problems, consequences of narrow networks and the inability to negotiate fair contracts. It didn’t seem to matter whether practices were large or small; these stories showed consistent, negative impacts on care delivery and increased physician burnout. Oculoplastic surgeon Ron Pelton, MD, PhD, summarized: “As a solo practice physician I feel unimportant to insurance companies and powerless to fight against them. I was surprised to find that even big practices feel the same way.” Perhaps more important, many stories about dealing with health plans highlighted how patients suffered as a result.

The listening session was particularly opportune as the DOI is in the middle of developing new regulations regarding network adequacy, along with considering whether or not to block the proposed merger of Anthem and Cigna. Subsequent to the meeting Commissioner Salazar and Director Neguse announced the creation of a special physician advisory committee to address some of these issues. CMS is encouraged by this decision because it clearly means that physicians were heard. This is another step in a longer series, and much more work remains.