Colorado Medical Society

Cover: Insurance company mergers must be rejected by regulators

Tuesday, March 01, 2016 12:00 PM

  • Colorado physicians are concerned about the impact the proposed mega-mergers between Anthem and Cigna and Aetna and Humana may have on their patients and their practice.
  • Click here to view open-ended responses to the CMS physician poll on mergers that underscores the depth of that concern, as well as an informative data graphic that illustrates the data in this story.

Eight years of survey research have pointed to intense concern among CMS members about the practices of commercial payers, from contracting to service authorization to claim reimbursement.

Physicians also increasingly shoulder the costs of helping patients understand and navigate their health insurance, including both the financial costs of wasted staff or physician time, as well as the immeasurable costs of degraded patient-physician relationships in exam rooms across our state.

It comes as no surprise that physicians – especially those who continue to survive in small, office-based practices – view the potential consolidation of Aetna-Humana and Anthem-Cigna with tremendous skepticism and concern.

Our recent survey concerning these mergers shows the following:

CMS members resoundingly reject mergers

Physicians expect higher premiums, less patient access if mergers are approved

Insurers currently exert significant market power over physicians

It is worth recalling data from our recent network adequacy survey, conducted in September 2015:

Just say no
Years of CMS member surveys and reams of studies of physician burnout point to a profession in crisis. Physicians prescribe medication or treatments and hope insurance companies will approve them. Then they fight to get paid for their work and face roadblocks and hassles at every turn, if they’re lucky enough not be rejected from a network or offered rates that force them out of business.

If approved, these mergers will only accelerate these trends, and put the survival of office-based, physician-owned practices in jeopardy. A decline in the number of independent voices standing up for the practice of medicine and for the rights of patients – including the humanity of medicine beyond dollars and red tape – will continue to degrade the trust between Colorado’s physicians and their patients, a trust that is imperative each time a new patient enters a doctor’s office for an initial examination.

Physicians are clear in their message today: Approving these mergers will harm care for Coloradans, and regulators should say no.

This survey was conducted online by the Colorado Medical Society. It includes 597 fully completed surveys, including 153 interviews with decision-makers (those who are directly involved in contract negotiations). An additional 138 members partially completed a survey; these results are included in the tabulated results as well.

The margin of error for the entire sample of 597 is ±4.01%, and for the sample of decision-makers it is ±8.3% at the 95% confidence level. Surveys were gathered from Dec. 29, 2015 to Jan. 21, 2016.

Questions were asked regarding both the Aetna-Humana merger and the Anthem-Cigna merger. Attitudes on these questions did not vary significantly between the two mergers; the data is presented for the Anthem-Cigna results.

Call to action: What Colorado physicians can do

1. Communicate your views on the mergers immediately by writing the state insurance commissioner, Marguerite Salazar. Send a copy of your letter to Colorado Gov. John Hickenlooper and Colorado Attorney General Cynthia Coffman.

Commissioner Marguerite Salazar
Division of Insurance, Colorado
Department of Regulatory Agencies
1560 Broadway, Ste 850
Denver, CO 80202

Governor John Hickenlooper
200 E Colfax, Room 136
Denver, CO 80203

Attorney General Cynthia Coffman
Colorado Department of Law
Ralph L. Carr Judicial Building
1300 Broadway, 10th Floor
Denver, CO 80203

2. The Colorado Division of Insurance will soon hold hearings on the proposed Anthem-Cigna merger. Email if you are interested in attending and possibly testifying on behalf of your practice. CMS will provide you with assistance.