At their first face-to-face meeting at Academy headquarters, the AAFP and Humana Inc. found some common ground on a variety of issues important to family medicine and a willingness to air their views on others.
AAFP President-Elect Rick Kellerman, M.D., of Wichita, Kan., said after the recent meeting that he and others representing the Academy took the opportunity to make a case for family physicians' concerns. "We gave Humana a truckload of feedback about their plans for performance measurement, payment for evaluation and management and preventive services on the same day of service, and other payment issues," he said.
Tom James, M.D., Humana's medical director of national and major accounts, said the meeting was an opportunity to initiate ongoing discussion between Humana and the AAFP. "We all have the same ultimate goal of ensuring that patients receive the right kind of care," said James. "Humana would like to get input from physicians and physicians groups as it proceeds in the development of tools to do that."
Some specific issues the two organizations discussed at the meeting included
Academy, Humana Exchange Ideas, Clarify Views
By Sheri Porter
3/15/2006
- support for quality measures endorsed by the Ambulatory Care Quality Alliance, or AQA, in Humana's preferred network programs, although Humana also uses measures that haven't been endorsed by the AQA;
- affirmation of the concept of a personal medical home, including the possibility of a future pilot project whereby Humana could test the value of the medical home and the feasibility of instituting a care management fee (i.e., money paid by the payer to the physician to oversee patient care; the fee would be over and above the cost of individual patient visits); and
- the adoption of the continuity of care record standard in the development of electronic patient records.
In addition, Humana discussed its real-time claims adjudication initiative that quickly calculates for the provider, at the time of service, the exact dollar amount of the patient's financial responsibility for the visit. The initiative has been introduced in Humana's San Antonio market and will roll out to other Humana markets throughout 2006.
Kellerman said the Academy likes the claims adjudication concept because it could help physicians' cash flow. "Though there are still some bugs to be worked out, we encouraged Humana to proceed with its real-time claims adjudication initiative," said Kellerman.
The meeting also was attended by Roger Diemert, M.D., Humana's Medicare medical director; AAFP EVP Douglas Henley, M.D.; Bruce Bagley, M.D., AAFP's medical director of quality improvement; and other staff from the Academy's Socioeconomics Division.
Kellerman said the Academy likes the claims adjudication concept because it could help physicians' cash flow. "Though there are still some bugs to be worked out, we encouraged Humana to proceed with its real-time claims adjudication initiative," said Kellerman.
The meeting also was attended by Roger Diemert, M.D., Humana's Medicare medical director; AAFP EVP Douglas Henley, M.D.; Bruce Bagley, M.D., AAFP's medical director of quality improvement; and other staff from the Academy's Socioeconomics Division.
