450 Texas Doctors Leave Aetna, Austin Hospital Officials Say Success Can Follow Walkout
A group of more than 450 Texas physicians made headlines around the nation in October for their decision to drop out of Aetna’s U.S. Healthcare Physician Network.
The New York Times calls it the biggest rebellion yet against a health insurance company. About 26,000 people will be forced to switch doctors or pay additional fees for care. Under normal circumstances, the patient typically has the most to lose and the least control over such aspects of their health plan. However, many industry experts agree that the reaction of the displaced patients will be critical to the end-result of this highly-publicized physician exodus.
Michael G. Dobbs, Aetna’s Dallas general manager recently told The Dallas Morning News that a large physician turnover was expected in an emerging managed care market.
“The resistance to managed care here and the kind of uprising that’s going on about managed care is going to settle down because it’s the only answer to providing access to quality care at reasonable costs,” he said.
Just down the road, in Austin, another group of health care providers believe that a similar walkout was instrumental in resolving contract issues with a major insurer.
In 1996, St. David’s Healthcare System was unable to successfully negotiate the inclusion of all area facilities into Prudential HealthCare Plans network. After several facility contracts were canceled by Prudential, the company dropped out of the plan altogether and began an aggressive advertising campaign against the insurer.
While the decision was painful at the time, hospital officials say that, in retrospect, the aggressive action achieved the hospital system’s goals and led to an improved relationship with the insurer. Part of the success of their efforts, they state, was in patient mobilization.
In November, 1996, Columbia/St. David’s ran a series of full-page ads playing off Prudenitial’s longtime “Piece of the Rock” slogan. The headline read, “If you think your health plan is rock solid, you may want to take a closer look.”
The advertisement featured a list of managed care networks that had agreements with St. David’s, formerly Columbia/St. David’s. The copy read, “By selecting one of these health plans instead of Prudential, you’re giving your employees the freedom to choose which health system they believe is right for them.”
Public Opinion Supports Medical Community
Preston Gee, Senior Vice-President of Marketing at St. David’s, believes the decision to campaign against the carrier was instrumental to the subsequent negotiations.
“We found, basically, that you don’t have a lot of advocates for the managed care community. We found that, as a rule of thumb, the people are most loyal to their physicians, then to their hospital, but there is not much support out there for managed care organizations,” Gee said.
“The lesson to be learned from this is that if you are running up a brick wall, you may want to take the case to the court of public opinion.”
A provider walkout is often confusing to the managed care members. Most members are uncomfortable with the uncertainty it brings to their health care needs. Often, members must call either the insurance company or doctor for clarification on how to arrange for future treatment.
“I do recall that we got a number of calls. Most of the questions were technical in nature. They wanted to know if they would be able to access the facility and if we would be becoming a Prudential provider in the future,” said Cindy Blackwell, Director of Payor Relations at St. David’s.
Although hospital officials were not able to assure patients at that time that a contract with Prudential would be signed, the agreement was finally worked out and Prudential was, a year later, back on the list of managed care groups associated with St. David’s. The hospital signed a new managed care agreement with Prudential in October, 1997. The agreement allowed all facilities into the network, including those that the insurer had sought to exclude in previous contract negotiations.
“I believe as we look back a full year later, we were able to mediate and become participating providers and serve the Prudential community. It has been mutually beneficial. Once two parties agree they are going to work together, then you can get things done. Prudential made a commitment that they wanted us in the network and we wanted to be in the network as long as we could achieve the same access at all facilities. We are pleased to be Prudential providers,” Blackwell said.
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