Top executives from many of the nation’s health insurers outlined a plan Tuesday that they say is the first unified effort to reduce hassles for patients and physicians.
The reforms can be accomplished within 12 months and mark the beginning of a more in-depth process that could take years, the Coalition for Quality Affordable Healthcare says.
“Somewhere along the line, we lost the trust of the American public,” says Leonard Schaeffer, chief executive of WellPoint, a coalition member. “Our industry has heard concerns expressed by consumers and health care professionals. We know that together, we must improve.”
The announcement comes as Congress continues to debate passage of a patient’s bill of rights, which is opposed by insurers, giving the American Medical Association (AMA) fodder to criticize the effort.
“Most of the elements they say they want to improve are in the patient’s bill of rights,” says Randolph Smoak Jr., AMA president. “They ought to show their actions are genuine and join us in seeing that it gets passed.”
Other critics say the plan falls short of addressing concerns most commonly expressed by patients and doctors, such as delays and the red tape involved in getting approval for procedures or referrals.
The reforms touch on common complaints: lack of information about plan benefits and confusion about which prescription drugs are covered.
But they don’t go as far as United Healthcare did last year when it stopped requiring patients to seek prior approval for many treatments. United is not a coalition member.
Initially, the coalition said it would create ways to easily compare plan benefits and establish Web-based databanks of information about which prescription drugs are covered by each insurer.
To please doctors, the coalition vowed to streamline the application process for doctors who want to provide services to managed care patients. The insurers also said they would not hinder patients from direct access to certain specialists, would pay for emergency care and provide “timely” review by independent doctors when treatments are denied.
But those efforts are already required by many states, HMO critics say.
“It’s not a real advance when you adopt reforms that have already been enacted into law in most states,” says Jamie Court of Consumers for Quality Care.