Tuesday, April 24, 2001 was a good day in Boston. On that day, NASW secured ValueOptions’ agreement that the company, one of the largest managed care companies in the country, would discontinue the use of the Secret Shop-per methodology to monitor clinicians’ appointment availability. In past issues of FOCUS we have highlighted the problems associated with this method, particularly the element of deception that exists when a ValueOptions staff person calls a clinician pretending to be a client and asks for an appointment. The waste of time spent on these fraudulent calls and the deception can in no way justify the benefit of identifying the few, if any, clinicians who may be intentionally violating their appointment availability obligations to the company.
This meeting was highly productive, with a cooperative tone. The meeting began with the surprise of CEO Ronald Dosoretz's immediate announcement that he strongly favored doing away with the Secret Shopper. Having been a practicing psychiatrist for many years, he acknowledged that as a provider he would not have liked being called by a secret shopper. It was heartening that the company management was in full agreement with NASW that it would be best to stop this practice. Actually, ValueOptions uses alternative approaches in other parts of the country, and other managed care organizations do as well.
The challenge for ValueOptions at this point is to switch over to another appointment access monitoring tool that does not jeopardize the company’s standing with the National Commission for Quality Assurance (NCQA), the National Company that sets the standards for Managed Care Organizations. In fact, NCQA lists several alternatives to the secret shopper.
NASW agreed to sign a joint letter with ValueOptions requesting that Value-Options not be penalized for "switching" measurement tools in the middle of an evaluation process, and to write a separate letter to NCQA about the matter. The letters to NCQA were drafted quickly in the meeting and approved by all present, so that there will be no delay in communication to NCQA of ValueOptions desire to end the use of the Secret Shopper tool.
Attending the meeting for Value Options were: Ronald Dosoretz, MD, CEO, William Butler, LCSW, Vice President of Provider Relations and Michael Lardiere, MSW, Director of Provider Relations Northeast Region. (As an aside, Dr. Dosoretz’s daughter is a social worker in the DC area.)
Attending for NASW were: Gary Bailey, Vice President National NASW; Carol Brill, Executive Director, NASW, MA Chapter; Mirean Coleman, Senior Staff Associate, National NASW; Mary Hall, President, NASW, MA Chapter; Donald Markum, Co-Chair of NASW’s HMO/Managed Care Committee and Carol Trust, Director of Clinical Issues and Continuing Education, NASW, MA Chapter.
NASW also raised an issue the Association has been advocating on for some time, that of adding clinical social work-ers in private practice to the out patient Medicaid network. NASW achieved agreement last year from leadership in the Division of Medical Assistance (where the Medicaid program is housed) that when the new contract for the out-patient Medicaid network is awarded this will be a requirement. Dr. Dosoretz confirmed ValueOptions’ commitment to add social workers to the out-patient Medicaid network, if ValueOptions is awarded the Medicaid contract. The decision will be announced this month.
A third issue discussed at the meeting was how to cut down administrative expenses so that better service could be provided to clients, and social workers could be reimbursed at higher rates. The ValueOptions administrators at the meeting said that if all their providers were on line they could cut down on the high cost of mailings to providers. Another benefit would be faster turn-around of provider reimbursement checks. ValueOptions said that they have negotiated a deal with a computer company for a reduction on the cost of a computer, and free computer set-up for their providers. ValueOptions also offered to provide free billing software to providers so that claims could be paid more efficiently.
It was a good day in Boston.