Regence BlueShield Reaches Out to Physicians in Partnership

May 15, 2001, 01:00 ET from Regence BlueShield

    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
     -- 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