Managed Care

 

HMOs and Doctors Agree To Disagree — But Just Why?

MANAGED CARE October 1998. © MediMedia USA
News and Commentary

HMOs and Doctors Agree To Disagree — But Just Why?

MANAGED CARE October 1998. ©1998 Stezzi Communications

Schisms between HMOs and physicians in two states:

In North Carolina, Blue Cross and Blue Shield's Personal Plan HMO severed relations with MedPartners primary care doctors Oct. 13. The Blues rejected MedPartners' "demand" for a payment hike of up to 30 percent, while MedPartners blasted the insurer's "decision to negotiate ... through the media."

In Texas, 95 physicians in the Health Texas Provider Network will stop seeing Aetna U.S. Healthcare patients Dec. 31 because of a dispute over referrals.

In an interesting juxtaposition, these events played out as a California Public Employees' Retirement System report suggested that much physician dissatisfaction about HMOs is misplaced. Headaches could be avoided, the authors say, if physicians took more time to understand plans' referral processes. The study was carried out with help from HealthNet and several medical groups.

Meetings

4th Partnering With ACOs Summit Los Angeles, CA October 27–28, 2014
PCMH & Shared Savings ACO Leadership Summit Nashville, TN November 3–4, 2014
2014 Annual HEDIS® and Star Ratings Symposium Nashville, TN November 3–4, 2014
Medicare Risk Adjustment, Revenue Management, & Star Ratings Fort Lauderdale, FL November 12–14, 2014
World Orphan Drug Congress Europe 2014 Brussels, Belgium 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
HealthIMPACT Southeast Tampa, FL January 23, 2015