Two major OPM initiatives are requiring fee-for-service FEHB plans to adopt certain HEDIS quality measures and to provide price and quality transparency. The American Medical Association voted at its annual meeting this week to adopt these related policies:
“Patient adherence to treatment plans: The AMA voted to recognize that patient adherence to any medical treatment program is necessary in order to achieve high quality and cost-effective health care, and agreed to develop a list of resources to help physicians and patients optimize adherence. “‘For any health or wellness program to succeed, we must find ways to help patients follow through on treatment plans,” said AMA President-elect Ronald M. Davis, MD. “The best health outcomes occur when the physician and patient work together toward a common goal.'””Health plan and insurer transparency: In support of consumer-directed health care and an end to the mystery of medical prices, the American Medical Association (AMA) today called on the health insurance industry to end efforts to conceal their pricing systems for medical services. “Physicians at the AMA Annual Meeting agreed that patients need price transparency from all sectors of the health care system, but noted that pricing is largely outside of physicians’ control. It is based on a complex array of factors that are controlled by health insurers and often imposed upon physicians. [Blog note — That’s rich. Health benefits are a more a price support for doctors than an insurance product — will you be upset if you don’t get a home owners insurance claim payment this year — no, because that’s real insurance covering a risk that you don’t want to materialize. ]
“AMA pledged to take actions that would promote true price transparency, including calling on health plans to make their payment policies, claims edits, benefit plan provisions and fee schedules available for public viewing.”As I have said on the blog in the past, doctors have to bury the hatchet with health plans and work cooperatively to control health care costs. Improving patient compliance with doctor directions is a step in the right direction but refusing to recognize their role in the price setting process is a step back.