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Physician satisfaction is associated with patient satisfaction, adherence to treatment recommendations, and quality. However, burnout is prevalent, and physician experience with health plans is likely a key contributor. We explored physician satisfaction with health plans and assessed physician and plan characteristics associated with greater satisfaction.Cross-sectional analysis of physician satisfaction surveys for US health plans in 2016.We assessed the association between health plan/physician characteristics and physician satisfaction domains using multivariable linear regression. The following satisfaction domains were outcomes of interest, measured by 5-point Likert scales: overall health plan rating, finance, utilization/quality management, network/care coordination, pharmacy, call center, provider relations, and recommendation of the plan to others' practices.We analyzed surveys from 3158 physicians on 74 health plans, representing a 12.6% response rate. We observed highest satisfaction in overall plan rating, finance, and call center domains (adjusted means = 3.25) and lowest satisfaction in the pharmacy domain (adjusted mean = 3.02). The largest and smallest plans and vertically integrated plans had the highest satisfaction; 76% and 66% of physicians recommended vertically integrated plans and non-vertically integrated plans, respectively, to others (P.001). Solo practitioners rated overall plan rating, finance, utilization/quality management, and pharmacy domains more favorably than did physicians in larger practices, whereas primary care physicians rated overall plan rating, finance, and utilization/quality management more favorably than did specialists.Our findings demonstrate opportunity to improve physician satisfaction with health plans, specifically in pharmacy/formulary management. As provider satisfaction is increasingly recognized as a critical outcome, our findings highlight intervention targets.

New models of health care have emerged over the past decade. Accountable care organizations and patient-centered medical homes are designed to improve the patient experience, enhance health care quality, and decrease cost. These models have been developed in the primary care domain and have yet to be tested in specialty care. Certain chronic diseases require principal care by a specialist or health care team. The specialty medical home would provide patient-centered care for specific populations of patients whose health care derives from a single chronic disease. This article defines the parameters for a specialty medical home and provides a specific payer-provider experience for the comprehensive care of an inflammatory bowel disease population.

BACKGROUND & AIMS: Specialty medical homes (SMHs) are a new healthcare model in which a multidisciplinary team and specialists manage patients with chronic diseases. As part of a large integrated payer–provider network, we formed an inflammatory bowel diseases (IBD) SMH and investigated its effects on healthcare use, disease activity, and quality of life (QoL). METHODS: We performed a retrospective analysis of 322 patients (58% female, mean age 34.6 years, 62% with Crohn’s disease, 32% with prior IBD surgery) enrolled in an IBD SMH, in conjunction with the UPMC Health Plan, from June 2015 through July 2016. Patients had at least 1 year of follow up. We evaluated changes in numbers of emergency department visits and hospitalizations from the year before vs after SMH enrollment. Secondary measures included IBD activity assessments and QoL. RESULTS: Compared to the year before IBD SMH enrollment, patients had a 47.3% reduction in emergency department visits (P

The patient-centered medical home is a promising model for improving access to high-quality care for more Americans at lower cost. However, feasible pathways for achieving a transformation from current primary care practices to this new model have yet to be fully identified. We report on the experience of UPMC Health Plan-part of a large, integrated delivery and financing system headquartered in Pittsburgh, Pennsylvania-in its efforts to support primary care practices as they converted to patient-centered medical homes. From 2008 through 2010, sites participating in the UPMC pilot achieved lower medical and pharmacy costs; more efficient service delivery, such as lower hospital admissions and readmissions and less use of hospital emergency departments; and a 160 percent return on the plan's investment when compared with nonparticipating sites. We suggest approaches that could spur the adoption and spread of the model, including that payers be offered incentives to enter into patient-centered medical home contracts with interested providers; that payers increase efforts to provide primary care practices with access to usable data on their patient populations; and that telehealth be instituted to connect care managers to patients and practices when in-person visits are not possible or necessary.