President’s letter: A different kind of PAC: The UnitedHealthCare story

Sunday, January 01, 2012 12:05 PM
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F. Brent Keeler, President
Colorado Medical Society

This is not an article about a political action committee. This is the story of the UnitedHealthCare (UHC) Physician Advisory Council (PAC), the result of six years of largely successful collaboration with the largest health coverage insurer in Colorado. It is “largely successful” because not every problem has been resolved; there are differences and issues that remain. We physicians have not gotten everything we have wanted, nor has UHC. New issues will arise. Yet, at its most-recent meeting, the members of the PAC agreed that it was time to tell the story. I was pleased to volunteer to use this space in Colorado Medicine. (Please don’t interpret this piece as an endorsement of UHC. My intent is to show that Colorado’s physicians have a proven track record of engaging in collaboration in lieu of confrontation.)

In December of 2005, UHC was in the process of acquiring Pacificare. The Colorado Medical Society leadership and staff were concerned about how this merger would affect our ability to care for patients who would be covered by the merged plans.

We were able to present these concerns to the Division of Insurance, and on December 20, 2005 the Insurance Commissioner issued an order directing UHC to engage in a PAC process with selected Colorado physicians. The original purpose was to address issues arising from the merger. The PAC physician membership was chosen by physicians – not by UHC. The DOI order was for a three-year time period. The first meeting was in March of 2006.

The first PAC meetings involved some adversity. Fortunately, everyone agreed to an evolution of the format. Each side named a co-chairman, and the agenda was jointly developed. The meeting venue was moved to CMS headquarters. The scope of work was widened to include all issues of concern to either party, not just those arising directly from the merger. Some of this evolution occurred as national leadership at UHC changed.

Here is a partial list of some subjects the PAC has considered:

  • Shortly after the merger, UHC contracted with LabCorp (nationally) for clinical laboratory work for its members. Many physicians had poor prior experience with LabCorp and there was a lot of concern about satisfactory service. Complaints and concerns were aired freely at the PAC. LabCorp management attended PAC meetings. Service gradually improved, with the PAC deserving some of the credit.
  • UHC rolled out its Physician Designation Program (PDP) in Colorado in 2006. The PDP has its flaws and inaccuracies, and it is still claims-based as opposed to clinical outcome-based. Still, the PDP has gone through several iterations for which the PAC can take partial credit. Of note, UHC sent national software experts to several PAC meetings and, as a result, the latest iteration allows a physician to use the UHC website to drill down to the individual patient level. For instance, physicians can ask questions such as whether Patient X actually received a hemoglobin A-1-C test even though no claim came through to trigger a credit in the PDP process.
  • UHC has a physician advocacy program office for Colorado. At least three full-time staffers work with physician offices on a variety of issues ranging from claims processing to prior authorization. This direct contact function is unique. I have personally used it, with very good results.
  • UHC’s Medical Director for Colorado Chris Stanley, MD, has been invaluable as a PAC member and co-chair. He was recognized with a Strange Bedfellow Award at the CMS Annual Meeting in September of 2009 for his service. Thank you Chris.
  • When the DOI order expired, the PAC could have disbanded. Instead, by mutual agreement, the PAC was extended voluntarily and indefinitely. We now meet quarterly. The atmosphere is friendly and collaborative. We do not always agree, but the style is not one of confrontation. We’ve learned you can catch more flies with honey than with vinegar.

Any physician interested in joining the PAC should contact Marilyn Rissmiller at Marilyn_Rissmiller@cms.org.


Posted in: Colorado Medicine | Practice Evolution | Payment Reform | Interacting With Payers
 

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