Managed Care - March 2009 - (Page 44) PLAN WATCH The Pursuit of Happy Docs Some health plans do a better job than others in bolstering physician satisfaction. Systems really matter. By Frank Diamond I “Having good working relationships with physicians means that their customers, who are the plan’s enrollees, are going to be happier,” says the AMA’s J. James Rohack, MD. t turns out that the National Committee for Quality Assurance, the Commonwealth Fund, Kaiser Family Foundation, America’s Health Insurance Plans, and the American Medical Association do not actually pinpoint particular health insurers that are the apples of doctors’ eyes. We did ask folks at Kaiser Permanente and they said “Docs love us!” but the skeptic in us keeps us wary, even though Kaiser officials supplied data that they say back up their assertion (See “Kaiser Keys on Communication,” on page 45.). Softball? Though most experts point to group-model insurers such as Kaiser Permanente as maintaining very physician-friendly environments, we couldn’t help but feel that we threw that plan a softball. Prop a microphone in front of any health plan official worth his salt and ask “Are your physicians happy?” and none of them — and we mean none of them — will say “No.” However, J. James Rohack, MD, presidentelect of the American Medical Association, finds that Kaiser Permanente’s pride in its physician relations is justifiable. “It’s an integrated system,” says Rohack. “The insurer, physician, and hospitals are all in line to make sure their communities are cared for and the dialogue is open so that there is complete transparency over how prices are set, how premiums are done, how coverage determinations are made.” Robert Pearl, MD, is the executive director and CEO of the Permanente Medical Group, which employs more than 6,000 physicians — the vast majority of whom are happy. “Harris Interactive did a report called the ‘Strategic Health Perspectives, 1995 to 2008,’” says Pearl. “I looked at the past five years, and the satisfaction — and these are physicians across the nation — declined from 70 percent “Quality of professional life is even more important than salary once incomes are competitive,” says Robert Pearl, MD, of Kaiser Permanente. to 59 percent, 11 percentage points.” He compares that to the data Kaiser collected for an internal study. “Over the same period at Kaiser Permanente, we increased by 9 points to a score over 80, although the scores are not exactly the same measurements. But essentially it’s a 20-point spread between what’s happened in community based medicine across the nation and the Permanente Medical Group with Kaiser Permanente. This level of satisfaction explains why we have eight applicants for every opening and are the first choice for graduating residents and fellows from across the country.” Which points to the first rule in keeping doctors happy: Give them autonomy. “You can’t underpay and expect to recruit and retain excellent physicians, but quality of professional life is even more important than salary once incomes are competitive,” says Pearl. “They have to be able to make decisions about what is best for their patients. One of the problems with the health insurers around us is that often that care is directed by the health plan. The doctors have to call for authorization and approval, as opposed to Kaiser Permanente where the physicians have that autonomy. There is no insurance clerk or insurance executive or anyone else that they need to call when they want to prescribe a medication, when they want to schedule an admission to the hospital, when they want to recommend a referral to a specialist colleague.” Room for autonomy Pearl contends that physicians who want to provide care differently in Kaiser Permanente can do so, assuming their quality outcomes are comparable, unlike in the fee-for-service world where they can’t without prior insurance company authorization. Physicians also appreciate advanced information technology, especially if the medical 44 MANAGED CARE / MARCH 2009
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