The messenger communicates with each physician individually about what terms the physician is willing to accept and then communicates this information to the health plan so it can offer a contract to all of the physicians at once. However, the messenger may not share information with the physicians. The process actually gives more information to the health plan while the physicians remain in the dark. As a matter of fact, use of this process is too risky because it can actually trigger an antitrust challenge. If enough physicians using the process end up rejecting the contract the health plan offers it can appear as if the messenger or the physicians illegally shared information.
Most physicians are independent contractors.
This requires either sharing substantial financial risk or integrating business operations, which is not always feasible. Forming, managing and operating networks or group practices is a very expensive and time consuming undertaking. Physicians are understandably reluctant to do this because it requires substantial capital, forces them to practice in a setting they may not prefer, and may not even provide antitrust protection because the guidelines are not entirely clear as to what constitutes an appropriate level of integration. Even if physicians receive a letter from the FTC approving an arrangement, they cannot rely on it as a guarantee against an antitrust challenge. Each determination under the antitrust laws is dependent on specific facts of the situation.