Improving medical resident perceptions of health plan decision making.

Objective: To determine the effect on medical residents' perceptions resulting from attending a medical policy meeting.

Study Design: Pre- and postsurveys administered to residents attending BlueCross BlueShield of Tennessee's (BCBST) Medical Policy Subcommittee meeting. This group is a subcommittee of the Medical Policy Review Committee (MPRC), which is responsible for the final approval of medical policies at BCBST.

Methods: Residents were invited to attend BCBST's Medical Policy Subcommittee meeting to determine what impact observing this process would have on their attitudes toward health insurers' use of scientific evidence. This subcommittee, which consists of both BCBST medical directors and network physicians, plays a key role in determining whether new medical technologies or new uses of established technologies are medically necessary, cosmetic, not medically necessary, or investigational. Residents were given a pre- and postsurvey to assess their attitudes regarding the methods insurance companies use to make coverage decisions.

Results: Medical residents rated BCBST's use of scientific evidence higher after attending the subcommittee meeting. Only 4 of the 10 residents surveyed prior to the subcommittee meeting agreed with the statement, "Insurance companies base their coverage decisions for medical treatment on scientific evidence." In the postsurvey, all 10 residents indicated that they agreed with the statement. Other questions showed similar positive changes in residents' opinions of the health plans' decision making.

Conclusions: Many medical residents likely have negative perceptions of health insurers and may be prone to believe that medical policy decisions are based predominantly on financial impact. Such attitudes can easily persist as they move into private practice. Although drawing firm conclusions from this small study is difficult, exposing residents to actual decision-making processes within insurance companies may be one means of improving their opinions of how such decisions are made.