MANAGED CARE October 2007. ©MediMedia USA
With all the noise made by providers about report cards for physicians and quality grading systems undertaken by payers, it stands to reason that eventually, payers would be put under a microscope, too. Results of a survey conducted by the
American Academy of Family Physicians and Family Practice Management magazine indicate that health plans have their own issues to work on.
"Managed care organizations have enough power to do what they want to physicians, especially those in small practices," says Robert L. Edsall, editor in chief of Family Practice Management magazine.
Thirty-two health plans were reviewed and respondents were asked to grade each health plan from A (excellent) to F (failing) in 11 areas:
- Payment rates
- Adherence to current procedural terminology in claims processing
- Timeliness of payments
- Accessibility, knowledge, and responsiveness to practice concerns
- Member eligibility and benefits information
- The payer's Web site
- Formularies
- Prior authorization
- Appeals process
- Contracting process
- Physician performance data
The average grade physicians awarded plans was C-minus. They performed best (only a solid C average) in three categories: "timeliness of payments," "member eligibility," and "payer's Web site." The category in which they received the lowest grade (D ) was "the contracting process."
Plans that did the best (C-plus) were MVP Health Plan, Regency Blue Cross Blue Shield, and Blue Cross Blue Shield of Florida.
"The medical director who cares about practicing physicians will lobby his or her organization to pay them at least what Medicare pays, pay them on time, and adhere to current procedural terminology in processing claims," says Edsall.
Because the sample was small, the surveyers caution physicians about the results and suggest that physicians "think of them as the advice you might receive if you were to ask your colleagues for input regarding their experience working with health plans."