MD GROUPS: Kaiser, Harvard Practices to End Exclusivity
Harvard Vanguard Medical Association and the Northeast Permanente Medical Group are in negotiations with HMOs other than Harvard Pilgrim and Kaiser Permanente, as the number of medical groups with exclusive HMO contracts continues to wane. With consumers' desire for choice fueling the trend away from exclusive agreements, Kaiser Permanente California and Group Health Cooperative in Washington are among the only such arrangements surviving. HVMA Chair Dr. Gene Lindsey said, "This puts us in a competitive position that allows patients to either choose us or not choose us on the basis of what they think of the quality of the care we offer and not on the basis of some vagary about insurance coverage." NPMG Executive Medical Director Dr. Stacy Lundin said, "What we actually had for the first time was one-way exclusivity -- where we were exclusive for the health plan but they had contracts with other providers. We knew that could not go on forever."
Managed care founding father Dr. Paul Ellwood isn't sure the shift away from the exclusive provider model is a positive one. He said, "In the long run, when health plans are put in a position where they have to compete on quality, they will go increasingly to exclusive arrangements with physicians rather than moving away from them." He added, "The only reason for a group that's exclusive to become nonexclusive is to get more enrollees. ... When the average primary care doctor is working for five health plans, the health plan has very little loyalty to the doctors, the doctors have very little loyalty to either. The thing that drives it is money" (Foubister, American Medical News, 5/3 issue).