Lawsuits Track New Flare-ups In Insurer/Doctor Relationship


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.

Career Opportunities

HAP, a subsidiary of Henry Ford Health System, is a nonprofit health plan providing coverage to individuals, companies and organizations. This executive develops strategies to meet membership and revenue targets through products, pricing, market segmentation and advertising.  Aligns business among Business Development, Commercial Sales, Medicare and Public Sector Programs and Product Development. Seeks to enhance and be responsible for business development and expansion through the development of an effective product portfolio, strong interpersonal relationships and service excellence.

Apply via email to jfedder1@hfhs.org or online at http://p.rfer.us/HENRYFORDlXqAJA

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