Physician survey: Not all managed care is bad

Yet paperwork, denial appeals still bother doctors

Does managed care impede physicians in their ability to provide high-quality care? Not necessarily, according to a recent survey of physicians in six major metropolitan areas.

While physicians bashed some health plans and lambasted "major hassles," they scored other managed care plans as high or higher than fee-for-service ones in the Quality Catalyst program of The MEDSTAT Group, a health care information firm based in Ann Arbor, MI. This is the only national health plan rating program that incorporates the physician perspective, says Dennis Becker, MEDSTAT senior vice president.

Paperwork and reimbursement hassles

Some health plans do interfere with care, but the fault lies with plan management rather than the managed care model itself, says Becker. Based on ratings from physicians and consumers, those poorly implemented plans aren’t likely to survive, he asserts.

For example, one-third of physicians called "getting help with appeals for denied claims" a "major hassle," and one-fourth similarly criticized the paperwork burden and claims reimbursement process. (For more information on physician ratings of hassles in managed care, see chart.)

"Those plans that look at their physicians as a strategic group to deliver on the mission of the health plan are going to be very successful," says Becker. "Those plans that ignore the voice of the physician as a key stakeholder probably will not be successful and [will not] survive long-term."

Physicians gave health plans widely varying ratings, with an overall average of 43-58 out of 100, which represents a neutral opinion. That was about 20 points lower than enrollees, who gave average scores of 68 to 79.

Results were adjusted for receptivity toward managed care, so scores represent actual differences among plans and weren’t skewed by physicians with overall negative feelings toward managed care, says Becker.

Some 9,000 physicians in six major metropolitan areas received surveys in 1997, asking their opinions about health plans, with a response rate of about 30%.

Results of a second survey of 40,000 physicians in 20 markets will be released this fall. The survey, conducted in conjunction with J.D. Power and Associates and the New England Medical Center, is also conducted among enrollees and corporate benefits managers.

Physicians and enrollees generally agreed on which were the best and worst health plans in the markets. That may reflect the influence physicians have on enrollee opinions about their health plans, says Becker.