Washington doctors, health plan agree on network structure

The deal requires Regence to explain its methods for measuring quality performance and gives physicians input in the process.

By Amy Lynn Sorrel, AMNews staff. Aug. 27, 2007.

As Regence BlueShield develops a performance-based network, Washington physicians will have their say in how it works thanks to a recent settlement with the health plan.

In a deal reached this month with the Washington State Medical Assn., the AMA/State Medical Societies Litigation Center and six individual plaintiff doctors, Regence agreed to include state doctors in the process before implementing a new network that grades physicians based on quality and cost efficiency. The insurer also made an undisclosed financial contribution to the WSMA Education and Research Foundation for projects to educate doctors on performance measurement issues and promote quality improvement programs in physicians' offices.

WSMA President W. Hugh Maloney Jr., MD, described quality programs like the one Regence proposed as "new territory" in which physicians' input is critical.

With the settlement, "we are going to be able to work collaboratively into the future, when possible, on similar issues that will put in place a mechanism that is going to advance transparency for the benefit of consumers and for our members to help them make better informed health care choices," Dr. Maloney said.

The agreement expires in two years. But it sets the stage for ongoing cooperation, Dr. Maloney said.

The AMA also praised the settlement in a joint statement with WSMA and Regence.

Regence officials, in a separate statement, said they were pleased with the resolution and seek to "better understand physician[s'] concerns" in their discussion of performance measurement. Regence made the financial contribution as part of their collaboration with WSMA, the statement read.