MANAGED CARE February 1998. ©1998 Stezzi Communications
It's been a year since the American Association of Health Plans said it would make compliance with its patient-centered policies a condition of membership. And never mind what you may read about those cold, heartless HMOs: Since that announcement, says Susan Pisano, vice president for communications, plans have embraced those policies full-bore.
"The overwhelming response from members is that this is the right thing to do," says Pisano. Those policies, including one discouraging outpatient mastectomies and another encouraging plans to communicate rules for ER coverage and appeals, are part of AAHP's Putting Patients First initiative.
The compliance requirement for membership took effect Jan. 1. Although it has only been a month, so far, so good --no plan has been denied membership renewal. How does AAHP know the membership is in line? Because plans say so on renewal applications.
Isn't that like trusting the fox with the henhouse? "We are going to look at whether we need to secure those findings another way," Pisano concedes.
"Maybe one area we'd like to learn more about is change. I don't think most plans have made information public about how physicians are paid. I would expect that when we ask plans about it, we would find that some of them need to make operational changes to be in compliance. Hopefully, we'll get a look at how we've been able to effect change."