CMS urges DOI to strengthen United-RMHP agreement
by Kate Alfano, CMS Communications Coordinator
On Jan. 10, CMS President-elect Robert Yakely, MD, testified before the Colorado Division of Insurance (DOI) at a hearing in Grand Junction to provide comments and recommendations on UnitedHealth Group’s proposed acquisition of Rocky Mountain Health Plans (RMHP).
Physicians and patients throughout Colorado and especially on the Western Slope are understandably concerned with the acquisition, specifically about long-term consequences it will have on patient care and how it will affect the long-standing relationships between RMHP and physicians that have been a model for the nation. As Yakely explained to the insurance commissioner, “The historical record of industry mergers demonstrates that whatever savings are realized through scaling efficiencies are not passed on to patients or their physicians. They simply give the health plans a bigger stick that exacerbates the already dangerous imbalances in physician-health plan business relationships, and clinical determinations.”
Understanding that the acquisition is proposed because RMHP’s board of directors believes it is the best path forward to advance the company’s mission of community-based and coordinated care, the CMS board of directors voted to examine this transaction and its real-world impact on physicians and patients to determine opportunities to enhance the agreement and expand collaboration with the merged companies if approved by state regulators.
Based on extensive discussion and evaluation, including numerous listening sessions and outreach to Western Slope physicians, CMS strongly urged the insurance commissioner to strengthen the acquisition agreement in the following ways:
1. Protect patients by prohibiting the merged company from passing on acquisition costs to patients or other Colorado consumers in the form of higher premiums, as was a condition in United’s acquisition of PacifiCare in California.
2. Establish a Physician Advisory Committee comprised primarily of actively practicing Western Slope physicians to provide input during the transition and on any far-reaching management or medical policy changes.
3. Require the merged companies to offer a professionally facilitated dialogue to each Western Slope and mountain-region IPA currently served by RMHP to enhance patient and community benefits.
4. Ensure continuity in leadership by guaranteeing employment of RMHP management, especially those who are involved in medical policy and physician relations.
5. Define “study, learn and apply” as United has said it will employ to implement RMHP best practices to the Front Range and around the country, and hold United accountable to this commitment to ensure positive outcomes.
Yakely testified that this acquisition is unique in that both plans have been open and forthcoming with information about the transaction and plans for the future. CMS urges the DOI to accept these recommendations to ensure, if approved, that Western Slope patients and physicians continue to benefit from innovative health plan practices and collaboration.
Click here for a link to the audio recording of the Jan. 10 hearing and to read the written testimony by CMS President Katie Lozano, MD, FACR, formally submitted to the DOI on Jan. 3. n
Posted in: Colorado Medicine | Practice Evolution | Payment Reform | Interacting With Payers