The Academy's strong and consistent message to insurance companies -- that the development and implementation of performance improvement and quality enhancement programs would go more smoothly with physician input up front -- has been heard by one of the country's largest insurance groups.
UnitedHealth Group, the parent company of UnitedHealthcare, recently established a national physician advisory committee that will, according to a press release, "provide expert physician guidance on the creation of programs to evaluate, report on and improve clinical quality."
The Academy applauded the move, and AAFP Board Chair Michael Fleming, M.D., of Shreveport, La., immediately appointed Bruce Bagley, M.D., AAFP medical director of quality improvement, to represent the Academy on the UnitedHealth Group Physician Advisory Committee.
"This is an opportunity for the insurance company to have direct physician input into proposed policies for performance measures, pay-for-performance programs and tiered networks," said Bagley, adding that it's likely that such initiatives, now being tested in some markets, will be pushed out to the entire UnitedHealthcare network in the future.
UnitedHealth Group's action is particularly notable in light of a visit the group's executives made to AAFP headquarters on May 31 to discuss, among other things, the Academy's objections to the UnitedHealth Performance SM Program. In April, the Academy sent a letter to UnitedHealth Group protesting the performance program. In the letter, Fleming said AAFP's concerns about the performance program would have been raised earlier "had United sought practicing physician input to the program's development and implementation."
Our objections were heard and a new process is in place, said Bagley. "Problems arose when United tried to do this without good physician input. I'm happy to have a seat at the table to comment and offer the physician perspective."
Bagley said he expects the committee to hold three to four meetings a year, some by conference call, with the first meeting scheduled for Sept. 23 in Minnetonka, Minn.
