HealthLeaders-InterStudy, the leading provider of managed care market intelligence, reports that Rochester physicians will likely continue rallying against local insurance giant Excellus BlueCross BlueShield, in an attempt to thwart its power in the local marketplace. According to the latest Rochester Market Overview, a new policy on imaging services and the insurer's move to individual physician contracts has the local physician community on edge.

"Excellus BlueCross BlueShield is the dominant insurer in the Rochester market," states Renee Burnham, market analyst for HealthLeaders-InterStudy and author of the report. "New policies and contracting methods are changing the structure of the provider market, especially as physicians seek to hold their ground on reimbursement."

Prior to 2007, Rochester physicians largely relied on contract negotiations conducted by three major independent physicians associations (IPAs) for reimbursement rates. However, effective Jan. 1, 2007, the payor giant terminated contracts with these IPAs, electing instead to contract with physicians individually. After some physician protest, most local providers ended up signing new contracts with the health plan.

Local physicians are also displeased with a new Excellus policy that requires them to obtain approval for imaging services. Excellus has a contract with Wappingers Falls, N.Y.-based CareCore National to manage member utilization of diagnostic imaging services. Under the plan that went into effect on Oct. 8, 2007, a physician is required to fill out a three-page form and submit it for approval, which can take up to two days in a non-urgent case.

About Market Overviews

Market Overviews provide a detailed analysis of local healthcare markets, allowing healthcare businesses to plan their local strategies.

About HealthLeaders-InterStudy

HealthLeaders-InterStudy is the authoritative source for managed care data, analysis, and news. For more information, please visit www.HealthLeaders-InterStudy.com.

  For more information, contact:    Kelly Morphy   HealthLeaders-InterStudy   615-369-4818   kmorphy@healthleaders-interstudy.com 

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SOURCE: HealthLeaders-InterStudy

CONTACT: Kelly Morphy of HealthLeaders-InterStudy, +1-615-369-4818,
kmorphy@healthleaders-interstudy.com

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