Managed Care

 

Lawsuits Track New Flare-ups In Insurer/Doctor Relationship

MANAGED CARE February 2009. © MediMedia USA
Editor's Memo

Lawsuits Track New Flare-ups In Insurer/Doctor Relationship

John Marcille
MANAGED CARE February 2009. ©MediMedia USA

John Marcille

There’s a lot about technology in this issue. A story examines how health plans are dealing with the genomics revolution. Read about some amazing patient-monitoring systems that promise a bright future for disease management. Then get a glimpse at how information technology might at last foster greater cooperation between health plans and provider networks.

I say “might” because I am a realist and so is the author of that article, Emad Rizk, MD. He cautions: “I am fond of saying that changes in health care come slowly because too many of us think we must boil the ocean before we can drink the water.”

I have been covering the managed care industry for about 17 years now and every once in a while I’ll edit a piece on just why health plans and doctors are tired of all the fussing and would just like to get along. Then the real world bursts in.

That’s as good a transition as any to our cover story. Contributing Editor Maureen Glabman lays out how health plans have more and more become the targets of litigation by providers, primarily physicians. It seems that doctors have much less compunction about going after a health insurance plan if they can do so as mostly anonymous participants in a class-action lawsuit. In the article, Maureen outlines how insurers can protect themselves.

Human nature hasn’t changed all that much, despite our technological advances. Please understand that I am not placing the blame solely on doctors. There’s plenty to go around in this tale of antagonism and mutual distrust, as Dr. Rizk implies.

Still, the mantra of hope is very much in vogue these days, so let’s grasp at straws. I understand that the Irish ceasefire still holds.

Meetings

Pharmaceutical Pricing and Contracting Conference Philadelphia, PA September 22–23, 2014
Private Health Insurance Exchanges Conference Washington, D.C. October 7–8, 2014
National Healthcare Facility Management Summit Palm Beach, FL October 16–17, 2014
National Healthcare CFO Summit Las Vegas, NV October 19–21, 2014
National Healthcare CXO Summit Las Vegas, NV October 19–21, 2014
Innovative Member Engagement Operations For Health Plans Las Vegas, NV October 20–21, 2014
4th Partnering With ACOs Summit Los Angeles, CA October 27–28, 2014
2014 Annual HEDIS® and Star Ratings Symposium Nashville, TN November 3–4, 2014
PCMH & Shared Savings ACO Leadership Summit Nashville, TN November 3–4, 2014
World Orphan Drug Congress Europe 2014 Brussels, Belgium November 12–14, 2014
Medicare Risk Adjustment, Revenue Management, & Star Ratings Fort Lauderdale, FL November 12–14, 2014
Healthcare Chief Medical Officer Forum Alexandria, VA November 13–14, 2014
Home Care Leadership Summit Atlanta, GA November 17–18, 2014