Executive office update: Climate change: physicians and plans warming to collaboration

Thursday, March 01, 2012 12:07 PM

Alfred Gilchrist, Chief Executive Officer
Colorado Medical Society

In our last issue, we discussed a work group on prior authorization jointly appointed by Colorado Medical Society and Colorado Association of Health Plans that includes practicing physicians and health plan medical directors. At the first meeting, when CMS President Brent Keeler, MD, was making introductions, he grinned and offhandedly noted to a health plan physician representative, “My wife taught you in grade school.” Despite the technical and serious nature of the discussions during the course of the work group, the conversations have been peppered with humor and remarkable candor. I was not surprised, nor were the physicians in the room, that competitors and potential rivals would share a sense of community and common purpose.

Maybe it’s the cosmic influence of the snow-capped mountain peaks as a backdrop to the almost year-round pleasant temperatures, or maybe it’s the Rocky Mountain way, but it seems Colorado leans toward fixing problems rather than blame. The prior authorization work group is having open, honest and realistic conversations about what needs to be accomplished and what can be accomplished. Everyone in the room understands that there could be an end point that requires political debate and resolution by elected officials at the state capitol, but there is also a strong commitment to a process that minimizes that outcome.

Many state medical associations weather recurring storm systems between and among health plans and sometimes find themselves drained of political capital as battles are waged on multiple fronts. Fortunately, the CMS leaders have shown a strong inclination toward evidence-based policy debates and continue to find creative solutions to complicated policy questions.

Our climate change began with a formal experiment in plan collaboration seven years ago with the CMS-UnitedHealth Group shotgun marriage imposed through a legal order by then-Insurance Commissioner David Rivera. The United PAC (physician advisory committee) was a condition of United-Health Group’s state-approved acquisition of Pacificare. That transformative period challenged our leadership to view the future of health care with a more complex view of the business as well as professional relationships. From 2005 through 2009, CMS passed a series of first-of-its-kind managed care reforms that standardized contracts, established legal criteria and physicians’ rights when profiled and updated the state’s insurance industry merger and acquisition statute.

Subsequently, CMS instituted a “Strange Bedfellows” award to recognize these vital collaborations. The first recipient was Mike Houtari, then CEO of the Colorado Association of Health Plans, and who now is legal counsel and chief lobbyist for Rocky Mountain Health Plans. He also currently chairs the Colorado Association of Health Plans. Chris Stanley, MD, formerly a practicing Denver-metro area pediatrician, was also awarded this rather unique distinction for all his steadfast work with CMS through United’s PAC.

These physician and health plan relationships are increasingly interwoven and interdependent; while they reside locally in this great state, their influence extends to nothing short of global collaboration.

Take Kevin Fitzgerald, MD, CMO for Rocky Mountain – he’s the incoming president of Mesa County Medical Society and recently represented Colorado in a CMS delegation of physicians in Washington DC who pressed the congressional delegation for a fix to the flawed Medicare funding formula known as the SGR. And CIGNA, now ramping up its own PAC, recently “acquired” CMS past-president Mark Laitos, MD, as its CMO. With 28 years of private practice under his belt, Mark is an American Medical Association alternate delegate. Then there’s Anthem’s Elizabeth (Cissy) Kraft, MD, who chairs HealthTeamWorks, formerly the Colorado Clinical Guidelines Collaborative. Cissy is an ardent champion of the patient-centered medical home. Chris Stanley, MD, is a CMS delegate and co-chairs our PAC with CMS past-president Lynn Parry, MD.

There’s a spirited song in the Broadway musical “Oklahoma” about the need for cooperation, set to the conflict between ranchers and farmers, that might be an appropriate metaphor for Colorado:

“Oh, the farmer and the cowman should be friends,
The cowman ropes a cow with ease,
The farmer steals her butter and cheese,
That’s no reason why they can’t be friends.”

“Territory folks should stick together,
Territory folks should all be pals,
Cowboys dance with farmer’s daughters,
Farmers dance with the rancher’s gals.”