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The American Journal of Managed Care July 2019
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Physician Satisfaction With Health Plans: Results From a National Survey
Natasha Parekh, MD, MS; Sheryl Savage; Amy Helwig, MD, MS; Patrick Alger, BS; Ilinca D. Metes, BS; Sandra McAnallen, MA, BSN; and William H. Shrank, MD, MSHS

Physician Satisfaction With Health Plans: Results From a National Survey

Natasha Parekh, MD, MS; Sheryl Savage; Amy Helwig, MD, MS; Patrick Alger, BS; Ilinca D. Metes, BS; Sandra McAnallen, MA, BSN; and William H. Shrank, MD, MSHS
Several physician and payer characteristics are associated with physician satisfaction with health plans. There is opportunity to improve physician satisfaction with payers, specifically in pharmacy.
RESULTS

We received surveys from 3158 physicians for 74 health plans (Table 1). Primary care physicians represented 62% of responders and specialists represented 38%. Fifty-one percent of responders were solo practitioners, and 55% were in practice for more than 15 years. Thirty-eight percent of physicians’ practices participated with more than 15 insurance companies. In terms of plan demographics, 11% of plans were vertically integrated and 89% of plans were not. Most plans had 500,000 or fewer enrollees and belonged to HHS regions 9 (San Francisco), 6 (Dallas), 5 (Chicago), and 4 (Atlanta).

Overall provider satisfaction varied little across domains, with highest satisfaction in the overall health plan rating (adjusted mean = 3.25), finance (adjusted mean = 3.25), and call center (adjusted mean = 3.25) domains and lowest satisfaction in the pharmacy domain (adjusted mean = 3.02) (eAppendix Table). Providers rated pharmacy significantly lower than all other domains (P <.05). The call center domain received the most “somewhat above average” and “well above average” ratings, whereas the pharmacy domain received the fewest “somewhat above average” and “well above average” ratings and the most “average” ratings (Figure 1).

In multivariable models, a number of health plan, provider, and practice characteristics were associated with physician satisfaction. Vertically integrated plans had significantly higher adjusted means than non–vertically integrated plans for all satisfaction domains (Figure 2; eAppendix Table), and the largest difference between vertically integrated and non–vertically integrated plans was observed in the overall health plan rating (β = 0.89; 95% CI, 0.61-1.17). Of note, 76% of providers would recommend vertically integrated plans and 66% of providers would recommend non–vertically integrated plans to other practices (P <.001). By plan size, physician satisfaction was highest for the largest (1,000,0001-2 million enrollees and >2 million enrollees) and smallest (≤100,000 enrollees) plans (Figure 2). Compared with practices with more than 1 physician, solo practitioners rated plans more favorably in overall health plan rating, finance, utilization/quality management, and pharmacy domains (Figure 3). Compared with primary care responders, specialists rated plans less favorably in overall health plan rating (β = –0.20; 95% CI, –0.31 to –0.11), finance (β = –0.21; 95% CI, –0.33 to –0.11), and utilization/quality management (β = –0.17; 95% CI, –0.27 to –0.06) (eAppendix Table).

DISCUSSION

Our findings demonstrate that with a mean overall plan rating of 3.25 of 5 points, significant opportunity exists to improve physician satisfaction with health plans, specifically in pharmacy/formulary management. Furthermore, we found that vertically integrated plans and the largest and smallest plans had the highest physician satisfaction overall. Solo practitioners rated overall health plan ratings, finance, utilization/quality management, and pharmacy domains more favorably than did physicians in larger practices, whereas primary care physicians rated overall health plan ratings, finance, and utilization/quality management domains more favorably than did specialists.

Vertical integration was a strong predictor of satisfaction; this could be due to perceived increased efficiency and streamlining of processes and initiatives, alignment of incentives, or engagement and participation in coverage and benefits policies. Other studies indicate that vertically integrated plans have better quality and patient satisfaction,12-15 although these studies did not include provider satisfaction as an outcome.

Plan size was an important predictor of physician satisfaction. Plans that serve more enrollees could have higher physician satisfaction because of increased organizational commitment and potentially more experience interacting with and supporting providers. These findings are consistent with those of studies on patient satisfaction that suggest that larger plan size is positively associated with higher satisfaction.16 Interestingly, we found that smaller plans also had high physician satisfaction, potentially because smaller plans tend to be community-based plans and thus may have more intimate community-based relationships and increased ability to customize care compared with larger plans.

Physician practice characteristics were also associated with satisfaction with health plans. Solo practitioners rated plans more favorably than did physicians in practices with more than 1 physician. This finding is consistent with those of studies demonstrating that practices with fewer physicians have higher physician satisfaction in general.10,17 Grembowski et al and Blechter et al explain this observation by the notion that as primary care physicians shift from solo to group practice, they become salaried employees who are more likely to have increased bureaucratic controls and reduced autonomy imposed on them.3,10,17 Physicians in larger practices may be less satisfied with health plans due to similar pressures.


 
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