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Home > Resources > eNews > June 2000 |
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The Managed Care Insider eNews Volume Two Number 5 June 2000 PART ONE 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 edition of the Insider eNews presents two views: provider and customer service, wants versus needs, for your consideration. The focus of Part One is on providers -- what they need and want to achieve a positive relationship with the health plan. Do they use the Internet? We hope this sparks some creative dialogue with you our subscribers and we hope you will take advantage of our online survey as well as emailing us with your suggestions -- insider@scheur.com ---------------------------------------------------------------- Insider Vision: Wants versus Needs By Barry S. Scheur, President, Scheur Management Group; Chairman, Venture Health Partnership Group We are at a crossroads for healthcare - failures not just of containing costs, but of trust and belief. Physicians don't trust health plans to pay them appropriately, to not interfere with the medical advice that they believe is in the patient's best interest, or even to be willing to discuss, as opposed to dictate contracts and policies. For the most part, health plans are the sworn enemies, and if not that, the feared antagonists. So what is the real truth when it comes to what physicians want? Are they rational in their trying to strike down all managed care? Are they acting like little children because their autonomy, not to mention their payment levels, have been undermined? Or are they willing to listen to and participate in framing rational alternatives? The questions are: Who's talking? and Who's listening? and Who's guilty? When you strip away all the rhetoric, unfulfilled promises, and antagonism, here's the simple truth. (1) Physicians want honesty about who's calling the shots and how they are getting paid. Define the plan's medical policy, referral and authorization procedures, appeals procedures, and then stick to them. Be honest when it comes to payment terms and risks. Don't promise return of withholds if there aren't going to be any. Tell the truth about fee schedules, and about old unresolved claims. (2) Physicians have a right to participate in shaping policy decisions about medical practice standards, so long as they are willing to stand by their decisions and support them with others. We, as the business side of the equation, need to listen more, talk less, and reach consensus together. (3) Physicians want to believe in something that is constant and doesn't reinforce their constant cynicism -- policies that don't change month to month based on costs rationalized as being medically necessary protocols. In other words, we have to create trust before we can ask for participation in change. (4) Physicians should be provided the resources to meet their needs in communicating with our customers. Is technology the answer? We believe that interactive discussions in health plans through the use of consumer boards and/or physicians advisory boards, or via technological advances, in nonaggressive, cooperative and collaborative sessions are the way to improve dialogue and services. Making our needs known in a non-threatening, productive manner enhances each group's chances of getting their needs met. ---------------------------------------------------------------- Using the Internet to Transform How Physicians and Managed Care Organizations Work By Mary Ellen Luff, Special Projects, Scheur Management Group A friend of mine was at a conference two years ago when the presenter began the session declaring, "Healthcare is changing at lightening speed." Then he asked, "Who are we kidding?" No industry has been slower to change than healthcare. Physician offices function essentially the same way they did 30 years ago, and nothing really earth shattering has happened with health plans since the advent of Medicare. For all the hype and promises of revolution, my friend was right. The industry has seen a lot of activity, but no real meaningful change in years. That was two years ago -- before, according to Forrester Research, a Cambridge, MA Market research firm, 52% of US households owned computers and 72% of them had Internet access; before the development of e-business where corporate America was using the Internet to transform core business functions, re-defining who they were and what they did; and before everyone from physicians to consumers to congress promised to put managed care organizations (MCOs) under the regulatory and legal knife if they didn't change how they conducted business. The U.S. is expecting and waiting for the healthcare industry to re-define itself. And for an industry known for its slow embrace of new technology, ironically, managed care has begun to turn its eye and its pocketbook to the Internet as the vehicle to spur fundamental changes in the way providers and insurers work with each other. However, the crucial first steps to getting physicians on board lies not in the technology, but in understanding their culture and processes, and creating mutual value and benefit. Lessons Learned - Different Cultures and Processes Remember, about ten years ago, when commercial labs decided to ease the administrative burden for physicians when they ordered and received test results? The labs installed state-of-the-art hardware and software, connected the practices via dial-up modem, and claimed success at automating the lab function. But the systems were self-contained and singly focused, and required the staff to enter patient demographic information twice - once into the practice management system and once into the lab system. Furthermore, many physicians dealt with seven or eight labs while the system was connected to just one vendor. The upshot was that only the physicians' children and a few errant staff members, who wanted to play Solitaire, used the computers. Not understanding the processes and culture of the physician practice turned out to be an expensive learning curve for the labs. Corporations involved in e-business have similar stories to tell, and they have some advice for new entrants. Technology issues can be overcome. The more difficult task, and the one crucial to success, is the willingness of the partners to delve deep into the processes and cultures of the enterprises. Once they understand them, they must be willing to turn the businesses upside down and inside out. That requires a lot of trust and a significant cultural change. Early on, these companies admit to pursuing e-business strategies more out of competition fears than believing they were critical to the future of their business. After all, they had a recipe for success under the old economy rules. But, according to a recent survey conducted by Booz Allen and Hamilton, business managers don't need to be convinced any longer that the Internet will be an important part of their future. Now their e-business strategies focus on mutual benefit. Finding Common Ground It's no secret that managed care has not been very successful at gaining the trust of providers or at thinking outwardly toward defining mutual benefit that spurs real change. And maybe, like corporate business managers a few years ago, managed care companies are not yet convinced that fundamental change is necessary or that e-health will play an important role in the future. But there is movement that suggests otherwise. According to Managed Healthcare Market Report, a recent review of 15 of the nation's largest HMOs found that most currently offer some level of online information to consumers and providers, such as lists of physicians, formulary and benefit product descriptions. Some have interactive capabilities, such as the ability to check claim status, locate physicians and check member eligibility. Online transactions such as enrollment, claims submissions and real time data for providers are less available, but are either in development or being considered by the plans. At least one very tangible mutual benefit has been identified that may encourage both physicians and HMOs to partner on some e-health ventures. An e-health industry that delivers administrative savings of just 5%, compounded, would save insurers and their customers a cumulative $14.7 billion over five years. Physician practices would reap cost savings, too. But equally important is the quality of professional life issue of eliminating the thorny and irritating practice management hassles that have relentlessly plagued their practices. Online applications that account for the swift pace of a physician's workday, eliminate irritating and costly administrative redundancies, and provide real time information will win the favor of physicians. But if MCOs are going to successfully lead the way, at a very minimum, the industry will need to implement the following crucial first steps: - Include practicing physicians in the strategic development process focusing on business strategy and mutual benefit, not just technology. If technology discussions dominate early, rest assured physicians will not get past the security and medical record confidentiality issues. - Develop a true understanding of each others processes and cultures - Identify a few processes that can be re-defined quickly and successfully. Not only will it help to build trust, but it will satisfy one cultural issue unique to physicians - the expectation of immediate results. - Provide support to help physicians sort through the barrage of technology "solutions" being thrown at them. There is no reason for physicians to spend the time or investment unless the e-solutions have a direct impact on the financial health of their practices, eliminate administrative hassles or support their ability to provide quality patient care. Doctors Online The following table, although specific to one HMO, is representative of the types of information HMOs are offering to providers. Intranet Page Avg # of hits per month % of times accessed by provider while on-line --------------------------------------------------------------------------------------------------------------------- Formulary search 39,600 95% Member eligibility and benefits check 34,600 83% Inpatient roster 25,850 62% Panel roster 18,760 45% On-line publications 14,595 35% Utilization reports 14,200 34% Physician Finders 12,925 31% All other screens (announcements, e-mail, etc.) 5,000 12% Source: Cigna Healthcare of Arizona Did this table come to you in a readable format? If not, visit http://www.scheur.com/scheur.nsf/smg/EzineArchVol2EPart1table.htm Where do you stand? We would like to hear from physicians. How are you using technology in your practice? SMG invites you to complete our brief survey on "Where Physicians Stand on Technology." As a thank you for completing this survey, we will give you a one-month free subscription to our new online knowledge management service e=mc2 (managed care squared). e=mc2 is a customized, knowledge management online service designed to provide healthcare professionals with the information power to achieve goals, manage systems and implement tools in strategic business development. It's another way of demonstrating our commitment to reshaping managed care with an emphasis on empowering providers with information. Follow this link to the Where Physicians Stand on Technology Survey: http://www.scheur.com/1technology/webpage/mcochallenge.nsf/ts62000 About the author: Mary Ellen Luff has experienced the health care industry from a unique combination of insider perspectives -- corporate human resources, physician practice management, integrated health systems, and most recently as the Regional Executive Director of a provider-owned HMO. Applying her 15 years of industry insight and broad-based management skills, she has put her expertise to work for providers who are striving to raise the bar for health care delivery. ---------------------------------------------------------------- End of PART ONE of TWO, The Managed Care Insider eNews, Volume Two, Number 5. 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, Mary Ellen Luff and Karen Cook. Editing and Research by Judith Jaffe. Production Coordination by Nancy K. Belle. 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 Go to June 2000 Part 2 |
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