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