Family doctors turn the tables, grade insurers

Physicians can give up to 10 health plans scores on items such as prior authorization and appeals processes.

By Jonathan G. Bethely, AMNews staff. Nov. 20, 2006.

Health plans are known for grading physicians on any number of measures. Now the American Academy of Family Physicians is joining a small number of physician organizations giving its members a chance to tell health plans what they think of them.

The academy is launching an online survey that asks members to grade plans on their payment rates, claims processing, formularies and other factors, with results scheduled to be published in the April 2007 AAFP publication Family Practice Management.

"There's not a lot for our family physicians to access when it comes to how a health plan is doing when it comes to timely payments," said Trevor Stone, AAFP's private sector advocacy manager.

"It allows physicians to get a better picture of how the health plans stack," he said. "When it comes time to negotiate, our members wanted to have some sort of way to measure how the health plan is doing with respect to other health plans."

Stone says there is another motivation to the survey -- giving physicians a chance to turn the tables on health plans that are increasingly using claims data and other means as a way to rate physicians for pay-for-performance or tiered network plans.

While the survey is only open to AAFP members, Stone said its results are applicable to other specialties because it spends time focusing on generalizations about physicians' interactions with health plans. For instance, the survey asks physicians to submit comments about plans and to identify which payer they would contract with if they could pick just one.