As President-elect of the American Medical Association (AMA), I am pleased to be here this morning representing our physician members across the country and their patients. The AMA expects this settlement to raise the bar for the entire health insurance industry on fair and open business practices.

We would particularly like to acknowledge the leadership, courage and perseverance of the individual physicians and state and county medical associations that took on managed care organizations many years ago and filed these lawsuits. It was a different environment then; and taking these legal actions was fraught with the possibility of retaliation and repercussions. Today’s announcement is proof positive that these individual physicians and their medical associations have not worked in vain. Physicians dedicated to their patients can make a difference and secure meaningful change.

Numerous studies have shown that a majority of physicians believe that managed care has decreased the amount of time they have to spend with their patients, increased paperwork and administrative hassles and disrupted the patient-physician relationship. Certain health plan business practices have continued to significantly reduce physicians’ ability to act in the best interests of their patients.

This agreement represents a fundamental shift in how Aetna will conduct business with patients and physicians now and in the future. We anticipate other health plans will recognize the progressive nature of this agreement if they are serious about restoring confidence in our health care system and repairing badly damaged relationships with physicians.

The AMA believes some of the most significant achievements in this agreement are:

• the public release of policies and procedures regarding Aetna’s medical treatment decisions and payment methodology;

   

• clearly delineated appeals mechanisms for external review;

   

• formation of an independent Foundation to deal with critical health care issues; and establishment of a National Advisory Committee of Practicing Physicians to provide advice to Aetna on issues of concern to physicians.

We are very pleased that Aetna has committed to expand the use of new technology to increase connectivity between physicians and Aetna’s claims processing and payment systems.

Of particular importance to physicians and patients across the country is the fact that this agreement will in no way preempt federal or state laws that protect patients and physicians.

The AMA would like to acknowledge the special role that Aetna’s Chairman and Chief Executive Officer Dr. Jack Rowe, a long-time AMA member, has played in bringing this settlement to fruition. We must believe that it is in no small measure a result of his own experience as a practicing physician and his commitment to patients. Aetna has made meaningful changes that will restore confidence in the integrity of Aetna’s business practices for physicians and patients.