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Home > Resources > eNews > Aug 2000 |
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The Managed Care Insider eNews Volume Two Number 7 August 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 issue of The Managed Care Insider eNews begins a series of articles that focuses on finding and keeping qualified professionals. In this issue, we explore the rhetorical question: Where have all the medical directors gone? Part One identifies the current HMO "no-win" situation in which medical directors straddle unsuccessfully between management and members. We deliver our solution in Part Two. Next month, The Managed Care Insider eNews will address the employer/employee relationship: What works. As always, we invite your comments and suggestions to insider@scheur.com. ---------------------------------------------------------------- Insider Vision By Barry S. Scheur, President, Scheur Management Group; Chairman, Venture Health Partnership Group WHERE HAVE ALL THE GOOD DOCS GONE? An Ode to a Needed New Breed of Medical Director So what else is new? Everyone still hates managed care, even as we try to define new parameters to make it more physician and customer friendly. And the medical directors really take it on the chin -- those physicians who, for the last twenty-five years, have been the evaluators and communicators of concurrent review, retrospective review, medical necessity, and experimental vs. acceptable courses of treatment. They have done this with honor, often knowing that they are not particularly well esteemed by the greater medical community in which they work. Medical directors have dealt with HEDIS, NCQA, and other standards of review and evaluation. And, yes, often they are cynical, with good cause, because of what they have tried to do and the grief they have gotten from their physician peers. Too often medical directors have been relegated by HMO management to the strictly medical "care and cost" arena, not recognized or treated as an essential part of the vision or mission of the company or of the senior management team. They have responsibility without authority, authority without necessary budgetary autonomy, and perceived power that doesn't quite equate to respect. Okay, so this is not always true, but it is, sadly, generally true. However, the times they are a-changin' and if we don't change with them, our struggle to reshape managed care to make it something palatable, workable, and marketable, will not be achieved. We need a new breed of medical directors, chief medical officers, or whatever titles you want to give them -- and we need them now. Medical directors perform a variety of functions relating to the establishment, enforcement, and interpretation of medical policy. For the most part, they have been concerned with referrals and utilization, the processes of credentialing, case review and standards of care. They analyze data and new programs, build medical models, and occasionally flirt with reimbursement. This is all good, but it's not enough. What they don't do, and recent interviews with medical director candidates for our health plans confirm this, is serve as physician educators and mentors for the clinical community. In this time of medical and consumer cynicism, we need more than ever to focus on the education of what managed care means, how it works, and how it can be made to work better for physicians and patients. And the chief communicator of this message, the chief facilitator of these necessary dialogues is a medical executive/manager who functions as an advocate -- for the company, for its fairness, and for its processes. ("Where Have All The Good Docs Gone?" continues in The Managed Care Insider eNews, Vol. 2 n7 Part Two.) ---------------------------------------------------------------- What's New? Speaking Engagements Barry S. Scheur: September 21, 2000 Mobile Association of Insurance and Financial Advisors October 6, 2000 Texas PHO Association Wyndham Hotel, Arlington, TX Managed Care: Is It Dead? ---------------------------------------------------------------- Gotta minute? We need YOU to visit our archive page, scroll down, and RATE US, please. Go to http://www.scheur.com/smghome.nsf/webcontent/ezinearchives.html Thanks! ---------------------------------------------------------------- End of PART ONE of TWO, The Managed Care Insider eNews, Volume Two, Number 7. 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. Contributing to this edition is Barry Scheur. 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 August 2000 Part 2 |
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