Thursday, August 23, 2007

Health Plans - HMOs and Beanbag

Politics ain’t beanbag, 'tis a man's game, and women, children 'n' prohibitionists had best stay out of it.

Finley Peter Dunne, 1867-1936, Chicago Humorist and Writer

In my last two posts, I spoke of physician leadership at the level of national politics and private innovation.

I neglected to speak of leadership of state medical societies. Two years ago, I interviewed Tim Norbeck, then executive director of the Connecticut State Medical Society for Voices of Health Reform (Physician Support Resources, Inc, 2005). Under Tim’s leadership, in 2001 the Connecticut Medical Society sued Connecticut HMOs for downcoding and artificial down bundling of physician.

Eventually in 2003, 19 medical societies joined with Connecticut to bring suit against Aetna, Cigna, Health Net, Prudential, WellPoint/Anthem, Humana, Blue Cross Blue Shield and 30 subsidiary Blue Cross Blue Shield plans eventually settled.

Settlements have amounted to $2.5 billion, including cash, future payments, and business changes. Out of these settlements in 2005 arose the Physicians Advocacy Institute (PAI), whose board includes nine state medical society executives. The purpose of PAI is to keep insurers feet to fire to comply with settlement terms.

According to Robert Seligman, PAI President and EVP of the North Carolina Medical Association, physicians will receive over $500 million in cash. Seligman says the PAI’s most important initiative is developing a Claims Data Warehouse, which will allow physicians to analyze claims data and prepare for future P4P programs which health plans are now implementing.

Dealing with HMOs ain’t beanbag; it’s hardball.
Here are other Finley Peter Dunne quotes.
"A fanatic is a man who does what he thinks the Lord would do if He knew the facts of the case."

"Trust everybody, but cut the cards."

"A man expected to train lobsters to fly in a year is called a lunatic; but a man who thinks men can be turned into angels by an election is a reformer & remains at large."

"An appeal is when you ask one court to show its contempt for another court."

"There is one thing to be said in favor of drink, and that is that it has caused many a lady to be loved that otherwise might have died single."

"Swearing was invented as a compromise between running away and fighting."

"You can lead a man up to the university, but you can't make him think."

"Minds are like parachutes; they only function when open."

"Alcohol is necessary for a man so that now and then he can have a good opinion of himself, undisturbed by the facts."

"Comfort the afflicted, afflict the comfortable."

"The best husbands stay bachelors; they're too considerate to get married."

"Freedom is like drink. If you take any at all, you might as well take enough to make you happy for awhile."

"A man has more fun wishing for the things he hasn't got than enjoying the things he has got."

"I wonder why you can always read a doctor's bill and you never can read his prescription."

"One of the strangest things about life is that the poor, who need money the most, are the very ones that never have it."

"When the American people get through with the English language, it will look as if it had been run over by a musical comedy."

"If you go to the zoo, always take something to feed the animals, even if the signs say 'Do Not Feed Animals'. It wasn't the animals that put them signs up."


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