A few family physicians have welcomed the opportunity to serve as a voice for family medicine by serving on physician advisory committees set up by some of the nation's largest insurance companies.
Physician Advisory Committees
FPs Seize Opportunity to Air Concerns With Insurers
By Sheri Porter
10/25/2006
"It is a major passion of mine to enhance the relationship between the physician and the large insurance companies in an effort just to make the daily practice of medicine friendlier and more hassle free," said Mitchell Miller, M.D., past president of the Virginia Academy of Family Physicians, former chair of the AAFP's Commission on Finance and Insurance, and a member of the WellPoint Inc. physician advisory committee. He also is past president of the Medical Society of Virginia.
Miller is typical of FP members of these types of committees. He participated in his first physician advisory committee meeting with WellPoint last July in Chicago after physician colleagues submitted his name as a committee candidate.
WellPoint, which merged with Anthem Inc. in 2004, organized its physician advisory committee as part of its settlement agreement from a 1999 class-action lawsuit. That lawsuit -- filed on behalf of 700,000 physicians nationwide -- alleged that some health insurance plans conspired to improperly deny, delay or reduce payments to physicians.
The purpose of the physician advisory committees is to "show greater cooperation on the part of the companies in dealing with some of the problems that physicians had identified in the lawsuit," said Miller. "Most family physicians I talk to love taking care of their patients; they hate dealing with the hassles of managed care and insurance companies."
Miller is typical of FP members of these types of committees. He participated in his first physician advisory committee meeting with WellPoint last July in Chicago after physician colleagues submitted his name as a committee candidate.
WellPoint, which merged with Anthem Inc. in 2004, organized its physician advisory committee as part of its settlement agreement from a 1999 class-action lawsuit. That lawsuit -- filed on behalf of 700,000 physicians nationwide -- alleged that some health insurance plans conspired to improperly deny, delay or reduce payments to physicians.
The purpose of the physician advisory committees is to "show greater cooperation on the part of the companies in dealing with some of the problems that physicians had identified in the lawsuit," said Miller. "Most family physicians I talk to love taking care of their patients; they hate dealing with the hassles of managed care and insurance companies."
Other family physicians currently serving on insurance company physician advisory committees and the companies with which they are working are
- Michael Workings, M.D., of Detroit, Aetna;
- Bruce Bagley, M.D., of Leawood, Kan., AAFP past president and AAFP's medical director of quality improvement; UnitedHealth Group
- AAFP Past President Warren Jones, M.D., of Ridgeland, Miss., CIGNA;
- Michael Brennan, M.D., of Phoenix, Humana;
- Mary Ann Barnes, M.D., of Edgewood, Ky., Humana;
- Steven Goldberg, M.D., of Prospect, Ky., Humana;
- Alan London, M.D., of Cleveland, WellPoint; and
- Hector Flores, M.D., of Montibello, Calif., Wellpoint.
Workings' and Bagley's names were submitted to the insurers on whose committee they serve by the AAFP.
Aetna, CIGNA and Humana also have court-mandated physician advisory committees. UnitedHealth Group has an active physician advisory group, although its formation was not a consequence of the lawsuit.
When Miller and the other physicians on WellPoint's physician committee sat down at the table with WellPoint EVP and Chief Medical Officer Sam Nussbaum, M.D., they spoke frankly about WellPoint's handling of issues that impact physicians including
When Miller and the other physicians on WellPoint's physician committee sat down at the table with WellPoint EVP and Chief Medical Officer Sam Nussbaum, M.D., they spoke frankly about WellPoint's handling of issues that impact physicians including
- quality measures,
- pay-for-performance programs,
- transparency,
- payment denials for required immunizations,
- coding modifiers and
- certification processes.
At that first meeting, "we didn't solve a lot, but we got a feel for each other," said Miller adding that the physicians detailed some of the hassles that drive practicing docs crazy. "The culture we set up was one of mutual respect, and that's how we're going to get things done," he said. "When we next meet in December, our plan is to broaden the discussion about those kinds of issues."
Nussbaum said his company views the physician advisory committee as a great opportunity to partner with physicians. "During our first meeting, we refined our mission and covered a broad array of topics," he said. "As you can imagine, the viewpoints were diverse and the dynamics terrific. Together we have a fantastic opportunity to learn from each other and find new common ground to improve health care clinical quality."
Will twice-yearly discussions between a few physicians and insurance giants lead to any real changes? "It's the key question to the whole thing," said Miller. When I was asked to do this that was my initial feeling -- we'll have a great conversation, and at the end of the day, we'll all shake hands and leave, and cuss each other under our breath."
But Miller said his experience has been positive. "WellPoint has played its cards fairly so far and has pledged that it's serious about doing this. I think even small steps will help fulfill my mission of easing the burden of the daily practice of medicine," said Miller adding that he invites feedback from colleagues about topics they'd like to see on future meeting agendas.
Nussbaum said his company views the physician advisory committee as a great opportunity to partner with physicians. "During our first meeting, we refined our mission and covered a broad array of topics," he said. "As you can imagine, the viewpoints were diverse and the dynamics terrific. Together we have a fantastic opportunity to learn from each other and find new common ground to improve health care clinical quality."
Will twice-yearly discussions between a few physicians and insurance giants lead to any real changes? "It's the key question to the whole thing," said Miller. When I was asked to do this that was my initial feeling -- we'll have a great conversation, and at the end of the day, we'll all shake hands and leave, and cuss each other under our breath."
But Miller said his experience has been positive. "WellPoint has played its cards fairly so far and has pledged that it's serious about doing this. I think even small steps will help fulfill my mission of easing the burden of the daily practice of medicine," said Miller adding that he invites feedback from colleagues about topics they'd like to see on future meeting agendas.
