Regence BlueShield Reaches Out to Physicians in Partnership
SEATTLE, May 15 /PRNewswire/ -- In support of today's announcement by the Blue Cross and Blue Shield Association (BCBSA), Regence BlueShield leaders highlighted their company's efforts to become the health plan that local physicians trust. (BCBSA announced today a set of visionary guidelines produced as part of its ongoing effort with the American Medical Association (AMA) to improve communications between physicians and health plans.) "Regence BlueShield is working to be the health plan in Washington state that has earned the trust of local physicians through an open and collaborative relationship," said Regence BlueShield President Mary O. McWilliams. "Today's announcement of collaboration on a national scale supports efforts we've made locally to strengthen the physician partnership." The BCBSA's Guidelines for the Role of Participating Physicians in Health Plans is comprised of 10 guidelines for how physicians and health plans can better work together to improve the health of patients. It addresses issues that traditionally have led to tension between physicians and health plans, including physician involvement in credentialing and clinically oriented decision-making committees. The Guidelines also encourage physicians to discuss all available treatment options with their patients -- but do not presume to dictate how physicians should communicate with their patients. "We're throwing off the 'managed care' disparagements that have generally covered the health plan industry," said Regence BlueShield Chief Medical Officer Jeff Robertson, M.D. "It never reflected the way we do business: we never gagged doctors, we've always included outside physician experts on appeals, we don't interfere with medical decision-making." Robertson points to several important pillars within the company's structure that support a strong partnership with local physicians, including: -- Physician directors on the Regence BlueShield Board. Six of the company's 15 directors are physicians and serve as the Medical Advisory Committee, weighing in on all significant policies affecting the physician/health plan relationship. -- Physician Advisory Panel. A group of 24 local physicians, representing a wide array of specialties, that engages in problem-solving efforts with Regence BlueShield to address reimbursement and administrative "hassle-factor" issues. -- Physician Ombudsman. This Regence BlueShield medical director advocates on behalf of physicians with the health plan, resolving individual physician concerns and rooting out policies and procedures that aren't working. Long-time Seattle OB/GYN physician Larry Donohue, MD, is the current ombudsman at Regence BlueShield. -- Physician Staff Advisory Panel. A group of 20 managers of physician practices that advises Regence BlueShield on ways to simplify administration and improve communication between the company and local physician practices. -- Peer review on appeals. Member and physician appeal processes that include independent, external review and an expedited response when necessary. -- No gag clause. Regence BlueShield physician contracts do not infringe on a doctor's ability to discuss all treatment options with patients. The company's contracts have never included a "gag clause." "The Regence Group participated in the process with BCBSA as they worked on these guidelines that now have the AMA's support as a step in the right direction. We're proud of that collaboration," said McWilliams. "I hope that it leads to further improvements between health plans and physicians, not just for our company but for all health plans and for health care consumers. I think it's natural for Blue Shield plans, which were originally formed by physicians, to be leading the way toward real and sustainable improvements in the physician-to-health-plan relationship." Regence BlueShield is the leading health plan in Washington and provides health care coverage to more than 1.1 million members. Regence BlueShield is a not-for-profit health plan. It is one of 45 independent licensees of the national Blue Cross and Blue Shield Association that collectively provides coverage to 80 million -- or one in four -- Americans. 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. MAKE YOUR OPINION COUNT - Click Here http://tbutton.prnewswire.com/prn/11690X16577149
SOURCE Regence BlueShield
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