The insurer-physician relationship: Improved, but still imperfect

Relations are not so tense these days between health insurers and physicians, but several issues still divide them, according to Managed Care magazine.

While tensions have de-escalated over the past decade as physicians have adjusted to a managed care environment, it's still not a perfect marriage. Ron Brooks, M.D., a senior network medical director at Independence Blue Cross in Philadelphia, told the magazine part of the change is that the physicians who began practicing in the last decade grew up with managed care as patients.

"They embrace the concept of doing the right thing at the right time at the right place," Brooks told the magazine. Independence Blue Cross also bases its coverage policies on evidence-based guidelines, which are accessible to physicians on online.

Another shift is that more physicians are employees of hospital groups and large physician practices, allowing them to participate in a financial arrangement that rewards quality and cost-effectiveness, according to Brooks.

Yet while the physician-payer relationship is more collegial, there are still tension points, said Robert L. Wergin, M.D., a family physician who runs his own practice in the small town of Milford, Nebraska, and is board chair of the American Academy of Family Physicians. Smaller practices still want to see less meddling by insurance companies, says Wergin, who argues that doctors who know their patients can still make the best decisions about the care they need.

Worries over the impact of the Affordable Care Act seem to encourage a better relationship, according to Managed Care magazine, although that isn't the view everywhere. There's still a lot of distrust by physicians when it comes to payers, and the ACA and proposed insurance company mergers continue to impact that relationship, as FierceHealthPayer previously reported. In fact, the American Medical Association has asked federal regulators to block two major insurer mergers--that of Aetna and Humana and Anthem with Cigna--and the American Hospital Association also opposes the consolidation.

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