By Carl Johnson, MD
In June, the Academy held a successful Medical Director’s Summit in Chicago. The Summit was designed to bring together dermatologists and medical directors at commercial insurance plans to discuss the challenges and opportunities for ensuring patient access to appropriate and high-quality dermatologic care.
Medical directors from Aetna, Highmark, and Humana attended, along with a dozen representatives of Academy leadership, including President Dirk Elston, MD, and Immediate Past President Daniel Siegel, MD. The participants engaged in an open dialogue about the practice of dermatology, the AAD’s initiatives to improve patient care, and coverage problems that affect the payer and dermatology communities.
An eye-opening discussion about coding and payment decisions revealed that some problems that appear to be simple to resolve are instead quite deep-seated and difficult to change.
Some of the highlights of the summit included:
- A robust discussion regarding the changing role of employers. More employers are choosing to self-insure and use commercial insurance companies as more of an intermediary to carry out their plans. This limits the discretion of medical directors because the employers are actively determining the limits of coverage. In addition, because of this sea change, it is no longer possible for insurers to have consistent policies because each purchaser can have different coverage criteria.
- The Mohs appropriate use criteria (AUC) was well received. The medical directors found the AUC helpful and encouraged the AAD to disseminate it widely. They also encouraged the AAD to be as specific as possible when drafting guidelines and appropriate use criteria.
- An eye-opening discussion about coding and payment decisions revealed that some problems that appear to be simple to resolve are instead quite deep-seated and difficult to change. Along those lines, the group had a lively discussion about bundled payments because this is an area of increased interest for payers. Following an active discussion about the multiple-procedure reduction policy, two of the payers — Humana and Aetna — indicated openness to considering whether they could modify their policies.
- The medical directors shared their perspectives on the importance of transparency in physician qualification, the need for outcomes data, and the increased importance of physician-education firms and data that compare physicians. They also shared their concerns about state insurance exchanges.
- One payer, Highmark, was interested in collaborating on teledermatology standards. AAD staff has provided follow-up information.
- Following an interesting discussion regarding dermatology workforce issues, one payer, Highmark, indicated an interest in collaborating with the Academy on ways to fund residency slots.
Overall, the participants expressed hearty accolades for the program. In particular, the medical directors expressed appreciation for being educated about topics in dermatology such as the specifics of Mohs surgery. The medical directors expressed a desire to continue these relationships.
Carl Johnson, MD, is chair of the Academy’s Private Sector Advocacy Task Force. He is board-certified in dermatology and pediatrics and spent 10 years in the U.S. Army and 20 years in dermatology private practice. He is now retired.
Email the Member to Member editor at email@example.com.