Saturday, January 19, 2008

Physicians and Health Plans - 2008 Forecast for Managed Care

"Health plans often declare that they want to have good relationships with their physicians. But UnitedHealthGroup has at least 315,000 reasons to be extra nice. That number represents the 2007 slide the insurer experienced in employer-sponsored and individual memberships. The company attributed the loss, in part, to frayed relations with patients and doctors.”

Emily Berry, “Enrollment Drop has United Vowing to be Nicer,” American Medical News, January 14, 2008

I’ve never been a fan of managed care. Indeed, in 1988 in And Who Shall Care for the Sick? The Corporate Transformation of Medicine in Minnesota (Medica Medicus, Minneapolis), I predicted patients and physicians would ultimately rebel or drop HMO plans. This week UnitedHealthCare Group announced it lost 315,000 members in 2007 and wants to make amends with doctors. The bloom is off the HMO rose.

On January 31, 1:30PM -3:00 PM, The Executive Report on Managed Care and The Managed Care Information Center will sponsor a live 90 minute audio and Webinar conference, with these discussants:

• Jim Adams, Executive Director, IBM Center for Healthcare Management

• Peter Kongstvedt, M.D., F.A.C.P, Health/Managed Care Consulting Services, Accenture

• Gregory J. Pepe, Principal with the law firm of Neubert, Pepe & Monteith

Notice no representative of the practicing physician community is present at the table. It’s as if those who deliver the care don’t really count.

Issued to be discussed include:

• uneasy relationships with doctors.

• continued rebellion by doctors

• inadequate reimbursement

• increasing costs

• who is going to foot the bill,

• health benefit cost increases

• contracting and negotiation issues

• claim denials

• impact of provider pay-for-performance programs

• growth and effectiveness of consumer driven health plans

• controversial quality rankings of doctors

• transparency

• reform initiatives

• health plan consolidation.

You might want to put in your two cents at the end of the following agenda
• Top managed care issues for 2008

• Emerging estrangement in the payer-physician arena

• Market forces and pressures leading to revolutionary change for health plans

• Will approaches to expanding coverage for all Americans be focused on individual coverage or employer-sponsored coverage?

• How entry of new health care business models might impact health plans

• changing role of the consumer

• increased focus on price and quality data transparency

• Proliferating physician ratings by consumers and health insurers

• Momentum of Pay-for-Performance into the private and public sectors

• Linking evidence-based medicine to P4P

• How physicians can successfully participate with P4P Measures

• New initiatives for improvement in quality

• Shifts away from payment for medical errors

• Need for IT support for new and disparate functions in health plans

• Resurgence of IPAs and PHOs as engines of change

This agenda will be followed by a live question and answer session. This is where you might want to weigh in.

For more information, visit or call
The Managed Care Information Center
PO Box 559, Allenwood, NJ 08720


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For my part one and all must browse on this.