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Home > Resources > eNews > Jan 2000 |
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The Managed Care Insider eNews Volume Two Number 1 January 2000 PART TWO of TWO Welcome to The Managed Care Insider eNews. You are receiving this because you have subscribed; the eNews is never sent unsolicited. Subscribe/unsubscribe information can be found at the end of this eNews. The Managed Care Insider eNews is published, copyrighted, and owned by The Scheur Management Group, Inc. (SMG), http://www.scheur.com and is distributed monthly, free to subscribers. If you wish to forward this edition, you may do so only if the edition is forwarded in its entirety. No reproduction of any part of this publication is permitted without the express permission of the publishers. ---------------------------------------------------------------- This issue of The Managed Care Insider eNews reflects passion, opinion, and views related to physicians, hospitals, health plans and health care professionals working together to provide services and/or access to the best possible health care for consumers. Much has been written lately about "provider relations" and the inclusion vs. exclusion of physicians in the management of patient care. In this issue, Insider eNews focuses on what our new affiliate company, Venture Health Partnership Group (VHPG), is doing to reshape the practice of managed care with increased provider participation, and on a physician's view of the unrealized power physicians hold in managing care. We hope it provokes response, stimulates discussion and challenges change. As always, we welcome your comments to insider@scheur.com. ---------------------------------------------------------------- Lessons Learned ... About Physicians by Paul Reich, M.D. Physicians continue to amaze me. Although they claim to be powerless in the face of managed care corporate giants, their behavior has brought many health maintenance organizations (HMOs) to their knees. Their power lies in their pens and computers as they order medical services for their patients. One axiom well known to HMO Medical Directors, who are paid to manage physicians in HMO networks, is simply stated: "Happy physicians are cost-effective physicians." The converse is also true and has led to the failure or near-failure of many HMOs as demonstrated by the following examples. A financially successful HMO in the Northeast experienced computer system failures and a large backlog of unpaid claims. Within a few months, medical costs escalated out of control and, even worse, the claims backlog prevented management from realizing how precarious their financial condition had become. Did physicians (out of anger and/or frustration) subconsciously "stick it" to the HMO by ordering more services / testing? Possibly, because other HMOs, comprised of the same physician network, did not experience a similar explosion of costs, or at least not to the same degree. In another example, an HMO's change in ownership/governance resulted in miscommunication and ill will. Previously, this HMO had an IPA Board of Directors, consisting of community physician leaders, who kept management apprised of the needs and the mood of its physicians, including providing physician feedback for the design/change of programs. The value of this physician partnership was lost on new managers; physician input was neither solicited nor desired. Not surprisingly, medical costs rose, due to increased utilization of services. Physician satisfaction with the HMO declined. A third example involved a physician hospital organization (PHO) that was offered a global capitation rate that its leadership determined was too low. Rather than accepting it, they decided to sever their relationship with the HMO. The PHO had incorporated the loss of revenue into its budget projections for the next year and began to transition the membership. Only at the very last minute was a compromise reached. The final capitation rate paid by the HMO might well have been less had it not outraged its longtime partners. The Lessons Learned: Physicians do have the power to make an impact upon the well-being of an HMO. It is prudent, therefore, for HMOs to maintain good relationships with network physicians. Other lessons of value include: (1) provide "world class" provider service, (2) pay fees or capitation rates that cover physician expenses and margins, (3) avoid claims payment backlogs at all costs, and (4) include physicians in all decisions that affect their practices and organizations. If necessary, obtain outside expertise to diagnose and treat the causes of physician dissatisfaction. Physicians who are included in decision-making and treated fairly will respond positively to the utilization, case management and disease management programs that are vital to the HMO's success. ---------------------------------------------------------------- About the author: Paul Reich, M.D. serves as SMG's Chief Medical Officer and is project director for its MCORE (Managed Care Operations and Revenue Enhancement) survey program. Dr. Reich's career spans 23 years as a practicing physician and eight years as a physician executive for Harvard Pilgrim Health Care. Dr. Reich is responsible for coordinating SMG's clinical services to clients in the areas of medical management, disease management, quality improvement, financial accountability and the integration of information systems and Internet applications with medical management programs. ---------------------------------------------------------------- What's New at SMG? Have you taken the Challenge? The MCO Challenge? Find out how fit your health plan is! It's easy; It's fast; and It's FREE! Visit our web site to find out more, http://www.scheur.com ---------------------------------------------------------------- e=mc squared: What is it? SMG is taking managed care to the next level, electronically, as we launch consulting for healthcare providers needing assistance with realistic Internet applications. And we are launching a new subscriber-based information service, coming to our web site January 17th! ---------------------------------------------------------------- Sites and Sounds on the Internet Since the theme of this edition of the eNews relates to provider relationships, particularly physicians, we are including sites which relate to physician management and services, as well as those sites and lists which afford information on group processes, team building, and communication skills. We hope you find them helpful. SMG takes no ownership of the following sites, nor does SMG endorse these sites which are presented solely as a resource for subscribers. The Top Ten Business List for Tips on managing businesses, all types of businesses. It's free and it's an email-based list to which you must subscribe. For details, go to Top Ten Business. Subscribe or unsubscribe at the Daily Cast website: http://www.dailycast.com or send an email message to toptenbusiness-on@lists.dailycast.com to subscribe. The American College of Managed Care Medicine founded in 1995 by physicians can be found at http://acmcm.org/index.htm Health Care Business Media to find out about the "pulse" of health care at http://www.healthcarebusiness.com/ For inspirational, motivational strategies for transforming your life and your business, try Anthony Robbins site, at http://www.tonyrobbins.com "How to Overcome Resistance to Change" article on SMARTBIZ at http://www.smartbiz.com/sbs/arts/pos7.htm For a comprehensive article on Group Dynamics, with links to management issues, team building, and more, visit http://www.onepine.demon.co.uk/mgrp.htm ---------------------------------------------------------------- End of PART TWO of TWO, The Managed Care Insider eNews, Volume Two, Number 1. Scheur Management Group (SMG) is one of the most experienced specialized healthcare operations management and business revitalization consulting firms in the country. Our expertise is in time-sensitive analyses, strategic business and market planning, operational re-engineering, and communications, as well as implementation of start-ups, expansions, and new products. The firm's clients cover the spectrum of insurers, managed care organizations, physician groups, integrated delivery systems, hospitals, employers, governmental entities, vendors, and other providers. Contributors to this edition are Barry Scheur and Dr. Paul Reich. Editing and Research by Judith Jaffe. Production Coordinator is The Gracefield Group at http://www.gracefield.com/gg/index.html TO SUBSCRIBE: visit http://www.scheur.com/smghome.nsf/webcontent/ezine.html or send e-mail to insider@scheur.com with the word SUBSCRIBE in the subject and name, email, company, title, and country in the message. TO UNSUBSCRIBE: send email message to insider@scheur.com with the word UNSUBSCRIBE in the subject. Please take a minute to visit our eNews page at http://www.scheur.com/smghome.nsf/webcontent/ezine.html for archives, subscriber information and to RATE our ezine. Get up-to-the-minute health care news on-line at www.scheur.com |
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