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AHA and AMA Ask Health Plans: Can't We All Just Get Along?

Cheryl Clark, for HealthLeaders Media, June 5, 2009

Top officials for the American Medical Association and the American Hospital Association agreed yesterday that they should set aside their long adversarial history with health plans and work together, not for their own bottom lines, but to improve the health of their patients with by adhering to comparative effectiveness research.

“We need to fundamentally change the relationship between America’s health plans, physicians and hospitals,” said Thomas Priselac, chairman of the AHA board and president and CEO of Cedars Sinai Hospital in Los Angeles, who called for “a paradigm shift” in the structure of how they interact and how they share information.

Nancy Nielsen, MD, president of the AMA, agreed, saying interactions have been “wildly adversarial” between health plans and doctors “for much of recent history. We are all trying to change that.”

The health leaders made their comments in San Diego before an audience of several hundred attending the annual convention of America's Health Insurance Plans.

Nielsen added that it's the AMA’s highest priority to get health insurance coverage for every American. “The fact that we have not as a country been able to figured out how to have affordable health insurance for our citizens is a moral stain on this nation,” she said. “It is time that we fix it.”

One overarching concern, however, is how physicians and hospitals can refocus their efforts on what works, rather than what patients want or what happens to be covered. “It is clearly in America’s physicians’ best interest to have really good comparative effectiveness research data,” Nielsen said.

She added that next week, AMA officials will announce a major cooperative effort with a health plan to work on a comparative effectiveness research project in one state and said that is evidence that cooperation is possible.

Priselac added that there’s a wonderful opportunity for health providers to gain information from health plans about utilization. “America's health plans have great amounts of data that’s very useful and helpful,” he said. “But they don't have the complete clinical record. We have the complete clinical record.”


Cheryl Clark is senior quality editor and California correspondent for HealthLeaders Media. She is a member of the Association of Health Care Journalists.
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