By Fraser Cobbe
Physicians have a unique vantage point on the short comings of the health care delivery system. They witness first-hand the impact of ever-increasing insurance premiums and out-of-pocket costs for their patients. Costs which strain family resources or make insurance coverage unobtainable. They bear the brunt of the administrative cost and frustrations of trying to secure medically necessary services for their patients through utilization controls enacted by insurance companies. For physicians in private practice, like most businesses, they experience the pain of the annual Group Health Insurance renewal cycle when they receive annual premium increases with little transparency over their utilization of services. And yet, there is constant downward pressure on reimbursement rates for physician services from governmental and commercial payers.
While the DCMA continues to fight for our members, reform of the system through legislative and regulatory pressure has admittedly been difficult. Success in those venues is never certain given the influence of other stakeholders.
This reality has led the DCMA to pursue programs that we can control and tools to help physicians reform care delivery where they can.
Just over a year ago, the DCMA announced a strategic partnership with FBMC and Physicians Health Benefits to create a self-funded health insurance platform for our physician members. The short-term goals of the program were to provide transparency, accountability and premium control for our physician practices that provide health insurance to their employees.
The long-term goal is to encourage more of our members, as well as other organizations and businesses in the community, to consider similar platforms that provide claims transparency, lower administrative costs, the ability to keep your excess premium, and bring down out-of-pocket costs for employees that utilize services strategically.
Since its launch, there have been many lessons learned and the program has morphed considerably. But the success we are having in reaching those goals with our current participants is extremely encouraging.
It seems like there might be a way after all for physicians to take back a little bit of control in the health care system. Reach out to the DCMA if you are interested in learning more.
Fraser Cobbe, Executive Director, Dade County Medical Association, can be reached at fcobbe@miamimed.com.
