By Jeffrey Barg

Published November 1999

• React to this article in the Discussion Forum.

John T. Kelly, M.D., Ph.D., is the director of Aetna U.S. Healthcare’s new Physician Relations Unit. Kelly was director of the Aetna subsidiary U.S. Quality Algorithms and director of the American Medical Association’s Office of Quality and Utilization Management.

JK: The mission is to create strong, effective, and lasting relationships with physicians based on mutual respect and a shared commitment to high quality, affordable health care. I’ll be working closely with our medical directors as well as with participating physicians to enhance communications and identify ways to improve the effectiveness of our physician relations.

JK: A key part of what we’re going to be focused on is getting accurate, reliable, useful information to physicians. One of the strategies to achieve that is to expand the use of the Internet in physicians’ offices. We’ve launched a campaign to assure that by the end of calendar year 2000, every physician’s office in the country has access to the Internet. We’ve called upon physician organizations to adopt the same goal.

JK: Health care is an information intensive activity. There’s a wide variety of administrative as well as clinical information which is important to optimize clinical practice. We’ve established a program called E-pay. If physicians submit their bills to us electronically we guarantee that we will pay their claims within fifteen days. We’ve already begun to provide access to our pharmacy formulary on our website. About two weeks ago, we began to publish our coverage policies on our website. As we continue through the final months of 1999, we’re committed to expanding the kind of information we publish on the Internet regarding other policies and procedures relating to our various health plans. Currently we mail a tremendous amount of information to physicians. In fact, almost every week we mail some new information to physicians. One of the challenges physicians face is to manage those various communications. So there are cataloging challenges. There are access challenges. One of the benefits in putting this information in electronic format is that the information can be arranged in a convenient and easy to use way and always be available. Physicians can know where they can find the information when they have a particular question.

JK: We will be publishing various forms which physicians use as they refer patients to specialists. We’ll also provide access to our provider directory, a list of physicians who participate in our various efforts. We also have performance measurements that we’ve collected. For example, we create various clinical performance reports regarding conditions such as asthma, diabetes, cardiac care and use of pharmaceuticals. Our intent is to publish this information on the Internet. Initially the kind of information that would be available publicly would be broad comparative information about how patients with various conditions are managed in a given geographic region. Over time, we anticipate establishing various forms of security so that we will be able to provide highly specific information regarding a physician’s own practice, which he or she can access to determine how their practice compares with their peers. We also anticipate that we would be distributing to them information about individual members along with suggestions physicians might consider regarding ways to manage those patients with those specific clinical conditions. Obviously, as we provide detailed information regarding a physician’s own practice or information regarding individual members that would be distributed through highly secure Internet technology, which we’re going to be developing over the next several months.

JK: The information we have suggests that approximately two-thirds of physicians have access to the Internet at home and approximately one-third have access to the Internet in their offices. One of the challenges that we face is to expand physicians access to the Internet in their office.

JK: We have communicated with all the major physician organizations in the country to identify the potential benefits of the use of the Internet. We have asked them to consider joining our campaign and to encourage physicians to access the Internet in their offices. So far we have had a consistently positive response from various organizations. Many of them have already begun efforts to explain the value of the Internet and to train physicians on how to use the Internet. What we are really trying to do here is to excelerate the rate of adoption of this technology.

JK: We will be approaching our mission--to build a strong effective and lasting relations with physicians--in several different ways. One part of our effort is geared toward individual physicians. Another part is geared toward physician organizations such as the American Medical Association, national medical specialty societies and state medical societies. We have already begun to expand our contact with those organizations. We have asked their help in advancing the Internet initiative. We have also begun to look for their help in expanding some of our quality initiatives. An organization like ours collects a tremendous amount of information regarding how patients are cared for throughout the country. We have various amounts of information on how conditions such as diabetes or congestive heart failure are cared for. What we find is that in many instances the care of those individuals can be improved. Oftentimes, we look at the guidelines of organizations such as the American College of Physicians or the American College of Cardiology or the American Academy of Pediatrics and then compare actual practice to those recommendations. And what we find is that there are still many Americans who are not receiving optimal quality care. Patients with high risk conditions such as diabetes or congestive heart failure are not receiving appropriate medications. Individuals who could benefit from certain preventative health care services such as immunizations, mammograms are not receiving them. So another part of our effort is to begin to share this kind of information with those organizations and to look for their assistance in trying to address the barriers to optimal quality care.

During the last years we have seen the managed care industry undergoing a tremendous amount of growth. And managed care is now the dominant form of health care financing in this country. That’s been a significant change. Some physicians and some physician organizations have various concerns regarding the growth of managed care and have at times been critical of various aspects of managed care. Another part of the effort of this unit is to understand where there may be concerns among physicians or physician organizations and to identify ways to address those situations.

JK: We are interested in any issues that affect physician relations. We work externally, as I described, but we also work internally with the many individuals within our organization that interact with physicians and try to identify ways to help improve physician relations. We will be working very closely with the other 160 medical directors within the organization. We have a large number of nurses who work with us who interact with physician’s offices as well as individuals called professional services coordinators.

As managed care has grown and various issues have been raised. Some have been regarding various contract issues and over the years we have made various adjustments to contracts. Last year we significantly revised our contracts to make it very clear how we wanted to conduct business with physicians as well as how we expected physicians to conduct business with our members. We encouraged physicians to discuss with our members and their patients all medical treatment options that might be beneficial for a patient. We also encourage physicians to discuss their financial arrangements with us with their patients.

We have occasionally been criticized by various physician groups. Oftentimes there is a significant amount of misinformation and many of the criticisms are frankly invalid. In fact, it was interesting that in Texas, after one of the groups that was critical of us subsequently went out of business, one of the members on its board indicated that Aetna U.S. Healthcare was criticized when in fact the real problem was mismanagement within the organization itself. The problem actually had nothing to do with Aetna U.S. Healthcare. We will attempt to address those areas of misinformation and to identify any areas of concern that might be raised.

JK: We believe that the approach whereby physicians who contract with us agree to care for all of our members regardless of which particular health plan or insurance product they’re in is extremely beneficial both to physicians and to consumers. It’s beneficial to physicians because members do not have to move from one physician office to another if they change their health plan. It’s beneficial to consumers for the same reason which is that it facilitates and promotes continuity of care so that even if an individual changes from one particular health plan to another or one particular insurance product to another, if their physician is already participating in our network, then they can continue with that same physician. So we see this as extremely pro-physician and pro-consumer. We obviously have been pleased that in those states that have chosen to review this that it has also been seen as a pro-consumer move. Even though we recognize that some physician organizations have raised concern, we remain optimistic that ultimately the benefits of this particular approach to physicians and consumers will be evident.