Practicing 10 minutes from Louisville, Kentucky (home to managed care giant HUMANA) in the 80's my then group of 5 physicians decided it was a matter of sinking or swimming. Humana manged to pretty much take control of the insurance plans of corporate entities in the region and, if we wanted to have any income, we had to play their game. It wasn't long before the rest of the insurance companies followed suit with their versions of managed care. Paul, opting out was not really a choice physicians could make. When 90% of your patients were employed by business that were now providing only managed care plans, turning your back on them and refusing to see them was not fiscally or ethically possible. We had no more leverage over the insurance companies then than you do now over the oil companies and their high cost of fuel. And, remember, in the 80's, we did not have a significant shortage of primary care physicians. There was also the concept of the primary care physician being the "GATE KEEPER". This was in some ways similar to Martin's "MEDICAL HOME" model and, it did empower us to some extent to control patient's self-referring to specialists. In theory, it was not all bad but, like many other good intentions, people got greedy (insurance companies) and they started suffocating physicians with more and more restrictions, paperwork, performance monitoring and less reimbursement. Martin's Medical Home Model would be good for us and good for our patients but only if it is controlled and monitored by us, not the 3rd party payors. It needs to be a tool to improve patient care, not reduce expenditures for care.
Leslie
