As healthcare reform ramps up and fists grip tighter around the almighty healthcare dollar, the ACR is moving ahead full force in advocating for your interests in the delivery of healthcare. Through what could be described as “offensive” and “defensive” strategies, the ACR is positioning itself as a visible and active player in the managed care marketplace.
Proactively Advocating for You
Under the direction of the Committee on Rheumatologic Care (CORC), the ACR is now taking a strong proactive stance in the insurance industry through:
- One-on-one meetings with medical directors;
- Draft policy review;
- ACR representation at key insurance industry functions;
- Enhanced systems to monitor and address health plan issues; and
- New educational opportunities for members.
ACR members will soon have access to policies and programs developed by CORC to assist you in your interactions with health plans as a partner in the delivery and financing of patient care.
ACR representatives are meeting directly with medical directors representing many of the top four health plans within each state as part of the ACR’s initiative to proactively engage insurers in promoting transparency and collaboration as partner stakeholders in the bigger healthcare system. The meetings with insurers promote an honest and candid dialogue regarding the needs and operational systems of both parties, with the expectation of streamlining administrative processes to reduce waste of time and money and effectively deliver the right care to the patient.
CORC Insurance Subcommittee
In March, CORC created the insurance subcommittee specifically to focus on payer advocacy initiatives. The committee includes both clinical and academic physicians, creating a dynamic and effective composition of talent and expertise, which goes far in advocating for appropriate access to care and medical practice.
This subcommittee will develop and implement strategies to promote and protect the delivery of care and extend advice to medical directors and insurance commissioners as appropriate. Through this group, the ACR directly seeks to hold plans accountable and ensure that decisions are transparent and appropriate. The committee plans to provide insurance companies with access to reliable information on draft medical policies, appropriate information on policy and program development, and a mechanism to understand issues relating to rheumatic disease.
Because the ACR has members nationwide, CORC must serve members representing locally based markets with a diversity of need. In order to establish a firm foundation for advocating for all members, the subcommittee will begin educational outreach efforts targeting state health insurance departments. Specifically, the subcommittee seeks to educate state insurance commissioners, along with the appropriate staff, about the challenges of treating rheumatic disease, the importance of encouraging policies that improve quality and efficiency, and the necessity of directing insurers toward policies that advance the welfare of the patients ACR members represent.
Empowering Members and Patients With Tools for Success
In order to support members in their own dealings with the health insurance industry, CORC seeks to provide ACR members with educational materials on emerging issues in the health insurance marketplace, as well as tools to equip members and patients to deal with these issues. Delivered through a new, enhanced section on the ACR Web site, these tools are organized include:
- Educational information on popular health plan administrative theories;
- Emerging programs and delivery methods;
- Toolkits for engaging insurers;
- Toolkits for patient engagement with insurers;
- A database of medical director contacts;
- A database of insurance commissioner contacts; and
- Explanation of the various regulatory agencies, with associated contact details.
Empowered with these tools, the ACR will gain innumerable advocates in the push for more rheumatology-friendly policies, programs, and processes.
Send Us Your Insurance Complaints
In an effort to better assist the membership in addressing both individual and system-wide insurance issues, the ACR has developed a standardized complaint form. This form will help us identify trends and issues before they escalate and will allow us to target the issues that mean the most to you. It will also streamline the information collection process and enable the ACR’s practice advocacy staff and insurance subcommittee to swiftly advocate for your interests.
Complaints data will be stored in a database that will allow the ACR to filter and aggregate your submissions and analyze the data to identify complaints specific to payers, issues, and geographic regions. These data will help the ACR in proactively identify trends in payer interaction with rheumatology practices and address issues before they escalate.
For more information on the ACR’s new standardized health plan complaint form and associated action plan, visit www.rheumatology.org. For more information on any of these programs please contact Itara Barnes at [email protected] or Antanya Chung at [email protected].