Blue Cross and Blue Shield Association Announces Effort To Improve Relations Between Nation's Physicians and Health Plans

American Medical Association To Share Recommendations with Members

May 15, 2001

CHICAGO - The Blue Cross and Blue Shield Association (BCBSA) today announced recommendations aimed at improving working relationships between the nation's physicians and health plans.  This visionary document - Guidelines for the Role of Participating Physicians in Health Plans - is a product of ongoing efforts between BCBSA and the American Medical Association (AMA) to improve communications between physicians and health plans. The AMA said it will share the guidelines with its member physicians. 

The Guidelines  - 10 recommendations for how physicians and health plans can better work together to improve the health of patients - addresses issues that traditionally have led to tension between physicians and health plans.  They are not directives, but aspirational goals for Blue Plans and their participating community physicians.

"Most of us believe that managed health care has taken a wrong turn when it comes to physician relations," said Scott P. Serota, president and CEO of BCBSA.  "In many cases, much of the tension between managed care companies and physicians over the last decade can be attributed to poor communication. The good news is we jointly believe the Guidelines can help us get back on track in improving relationships.  The better news is that we are beginning a process that should lead to constructive discussions about many other topics in the future."

"We are pleased that the Blue Cross and Blue Shield Association is working with us in taking steps to address the concerns of physicians," said D. Ted Lewers, M.D., chair, AMA Board of Trustees.  "We will distribute these Guidelines to our physician members and hope they can be used in our mutual efforts to help improve patient care as well as the working relationship between physicians and Blue Plans."

BCBSA's Guidelines address issues from physician involvement in credentialing at Blue Plans to physician participation in Blue Plan clinical decision-making committees.  They also encourage physicians to discuss all available treatment options with their patients - but do not presume to dictate how physicians should communicate with those patients.

"Unfortunately, many of our past efforts have been misinterpreted as impeding physician and patient relationships," said Allan M. Korn, M.D., chief medical officer of BCBSA.  "The Blues believe physicians who care for and interact daily with patients should be involved in shaping health plan policies that impact patient care."

Noting that the Guidelines are based on current, official AMA policy for physician involvement in health plans and integrated delivery systems as well as successful experiences by Blue Plans across the country, Dr. Korn said, "We all recognize that the Guidelines do not address all of the issues between us.  Our hope is that these recommendations will serve as a way to open the dialogue between us and create more opportunities for collaboration to benefit the membership of both organizations, but more importantly, our patients.  Serving patients' needs is the goal for both the AMA and BCBSA members."