Oct 2006 Table of Contents

FROM THE EDITOR

Hand Your Health Plans a Report Card



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Here’s your chance to say what you think about your payers – and make your words count.

Fam Pract Manag. 2006 Oct;13(9):14.

While our cover illustration takes a humorous view of the situation, the situation itself is hardly humorous. Health plans wield considerable power in the current health care system power disproportionate to the value they add. For a long time, they have seemed to hold all the cards, handling contract “negotiations” with most practices as take-it-or-leave-it affairs. In the current marketplace, it’s true that the payers do tend to have strong bargaining positions, but you may not be as powerless against them as you feel.

If knowledge is indeed power, we hope that the results of the “AAFP/FPM Survey of Physicians’ Experiences With Third-Party Payers” will give you a bit more power. You’ll certainly know more about many of the plans in your area. Perhaps this knowledge will help you decide, in the context of your practice’s situation, whether your answer to the next take-it-or-leave-it contract offer you get from Plan X should be, “Leave it.” Or perhaps it will give you reason, and a little leverage, to press harder for contract provisions to fix the most troublesome aspects of dealing with Plan Y.

Of course, the survey data will be useful only in proportion to the number of physicians who complete the survey and the thoughtfulness of their input. So please, if you are an AAFP member, take the survey. As our article explains, it’s designed to allow you to rate just the plans you deal with, and it shouldn’t take long. You do have to get online to take the survey, though; we couldn’t manage the combinations of plans available in all 50 states with a paper survey. So even if online is not your favorite place to be, venture into cyberspace this time and strike a blow for family physician knowledge – and power. We’ll publish the results of the survey next April.

To offer you a bit more help in dealing with your payers, this issue also contains an article titled “Managed Care Administrative Tasks: Cutting the Red Tape.” In addition, we’ll be publishing an article on contract analysis and negotiation in an upcoming issue. While “contract negotiation” may seem like an oxymoron in the context of health plan contracting, I think you’ll find the article full of surprisingly useful advice – with the survey report an effective companion piece when it appears next spring.

Robert Edsall, Editor-in-Chief

Copyright © 2006 by the American Academy of Family Physicians.
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