Regence BlueShield, Physician Leaders Agree That Revised Contract Responds To Provider Concerns

Dec 15, 1998, 00:00 ET from Regence BlueShield

    SEATTLE, Dec. 15 /PRNewswire/ -- Regence BlueShield and the Washington
 State Medical Association, following several months of collaborative review
 and revisions, have agreed that a contract first offered to more than
 15,000 physicians and other health care providers last summer now contains
 significant improvements that benefit both providers and patients.
     The Washington State Medical Association got involved in September when
 many physicians voiced their objections to the new Regence BlueShield
 contract. In addition, the Office of the Insurance Commissioner has finished
 reviewing the revised contract and has concluded that the agreement is in
 compliance with state law.
     "The physician community is at the heart of what we do as a health plan,"
 said Rich Nelson, president and chief executive officer of Regence BlueShield.
 "Our ability to work collaboratively with doctors is critical. Our initial
 process for creating this new contract did not involve the physician
 community. Throughout the last three months, we have worked diligently with
 the Washington State Medical Association and other community providers on
 changes to this contract. This is a positive step toward forging more
 collaborative working relationships with our practitioners."
     "Regence BlueShield has responded seriously to our concerns," said Dr.
 Mark Adams, President of the Washington State Medical Association. "The new
 contract is a definite improvement."
     The Washington State Coalition of Mental Health Professionals and
 Consumers and the Washington State Society for Clinical Social Work consider
 the agreement a significant improvement and agree that it "should be put to
 providers for their consideration," according to Laura Groshong, BCD, a
 clinical social worker who represents both organizations. "We have a much
 better working relationship with Regence BlueShield today, and we plan to work
 together in the future," she said.
     The biggest problem physicians had with the Regence BlueShield contract
 focused on medical necessity. The medical association and other providers said
 the initial contract appeared to put the health insurer in the position of
 determining what is medically necessary for a patient.
     Regence BlueShield maintained that was never the case, but the health plan
 did make significant efforts to change the contract language, making it
 clearer to physicians and other providers that the doctor is always solely
 responsible for making medical decisions on behalf of a patient.
     "Physicians are the patient's advocate and we believe this contract
 enables doctors to put their patients first," said Dr. Donald Storey, Regence
 BlueShield Medical Director. "We've worked hard to ensure that this contract
 reflects the concerns our physicians voiced to us on medical necessity and
 many other issues. We've worked closely with the Washington State Medical
 Association and other providers to hear their concerns and reflect their input
 in this new contract."
     The revised Regence BlueShield contracts will be distributed to providers
 beginning in January 1999. All providers have continued to be covered under
 their previous contracts -- no interruption occurred while the revisions to
 the new contract were being made.
     "This is all very good news for health care consumers -- the state's
 leading health plan and the state's leading physician organization have worked
 collaboratively on an issue critical to all of us," said Nelson. "And we
 intend to continue to work collaboratively with our provider community on a
 wide range of issues. While we won't always agree on everything, it is
 essential that we begin building the trust needed to come together and resolve
 the many tough issues facing health care today."
     Regence BlueShield is the leading health plan in Washington state and
 provides health care coverage to more than 1.1 million subscribers in
 16 Washington counties. The company has about $1.4 billion in revenues.
 Regence BlueShield is a non-profit health plan, one of 55 independent
 licensees of the national Blue Cross and Blue Shield Association. It is also
 an affiliate of The Regence Group, an alliance of Northwest health plans which
 includes:  Regence BlueCross BlueShield of Oregon, Regence BlueShield of Idaho
 and Regence BlueCross BlueShield of Utah.
     CONTACT:  Chris Bruzzo of Regence BlueShield, 206-389-7955

SOURCE Regence BlueShield