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EMPLOYER
BASED HEALTH CARE:
THE CASE AGAINST "ANY WILLING PROVIDER"
The managed care
system was developed in response to dramatic increases in premiums that
were limiting the ability of employers to provide quality health care
benefits for their employees. An integral part of several forms of managed
care is the careful selection of a limited network of providers with
which health plans can negotiate contracts. The careful selection of
skilled, efficient providers is at the heart of coordinating patient
care, ensuring quality treatment and maintaining cost effective medical
care.
New legislative proposals that are being advanced under the guise of
"protecting" consumer choice would actually make health care
coverage much more expensive, lower overall quality and result in fewer
choices for us all.
The "Any Willing Provider" concept requires managed care plans
to accept any provider who claims to be willing to meet the plan's terms
and fee schedule. This seriously undermines the goals of managed care,
cost containment and increased quality, by limiting a plan's ability
to select high quality, cost-effective providers. In fact, the Any Willing
Provider (AWP) concept makes it virtually impossible for any managed
care plan to select and maintain a high quality network of providers.
AWP lessens the plan's ability to assure patient volume to physicians
resulting in higher cost.
Some types of managed care plans attract providers by guaranteeing access
to a specified pool of enrollees. If any willing provider in a community
must be allowed to participate in a managed care plan, there will be
an increase in the provider fees and administrative costs because patients
will not be directed only to the participants in a limited network.
As the costs to the plan increase, savings can no longer be passed along
to the consumers. According to studies, any willing provider laws could
increase annual premiums by as much as $1,284 for a family and $458
per individual employee. Health care coverage will simply become unaffordable
for many individuals while others may find that their only choice is
to reduce their health benefits.
AWP eliminates the ability of a managed care plan to select the most
qualified providers and ensure compliance with quality initiatives.
Employers and their employees expect managed care plans to build and
maintain networks of high quality, cost-effective providers. The AWP
concept is designed to lower the selection standards used by managed
care plans and weaken the ability of a plan to remove incompetent or
inefficient providers from the provider network.
In other words, the AWP concept is designed to be protection for the
providers that provide a service level that no consumer of health care
services should be required to accept. Accordingly, the AWP concept
can be viewed as an anti-consumer measure because it prevents a managed
care plan from protecting plan members from incompetent and/or inefficient
providers.
AWP eliminates the ability of employers to choose the managed care plans
they wish to purchase for their employees.
In our employer-based health care benefit system employers largely bear
the financial burden of the medical cost incurred by their employees
and their families. In order to keep medical costs inflation under control,
employers have elected to use managed care techniques such as establishing
qualified provider networks and applying quality assurance processes
to the utilization of medical services. The use of managed care plans
has permitted employers to continue offering meaningful health care
benefit plans to their employees.
Conclusion
The AWP concept will undermine the ability of managed care plans to
select the most qualified providers, cover appropriate medical treatment
and control health care costs paid for by employers and employees. It
will jeopardize the ability of small employers to offer health care
benefits to their workers. The unfortunate result will be higher health
care premiums and fewer insured Ohioans.
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