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
(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
-- 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
-- Peer review on appeals. Member and physician appeal processes that
include independent, external review and an expedited response when
-- 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.
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SOURCE Regence BlueShield