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The Managed Care Insider eNews
Volume Three Number 7
July 2001
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Managed Care Insider eNews is published, copyrighted, and owned by The Scheur
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This issue of The Managed Care Insider eNews focuses on the adjustments any practicing
physicians deal with when becoming medical directors of healthcare organizations,
including managed care organizations.
As always, we want to hear from you. Email your comments to insider@scheur.com
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Three Steps To A Better Medical Director
By Paul R. Reich, M.D.
Modern day healthcare organizations hire medical directors for their clinical
knowledge, business acumen and leadership abilities. The new medical directors
come with impressive credentials, a doctorate in medicine and often a master's
degree in business, healthcare or other related field. Many have years of clinical
experience in primary or specialty care, often serving as leaders in their local
medical community. However, many medical directors fail, as evidenced by the
high turnover rate, particularly in for-profit health plans, and the dissatisfaction
expressed by many currently employed in HMOs, hospitals and healthcare businesses.
Successful medical directors demonstrate expertise in three areas:
- clinical knowledge
- business acumen, be it an HMO, hospital or Internet company
- leadership ability
Healthcare companies must improve their medical directors' training and experience
in each of these three areas if they are to retain them and, at the same time,
grow their business.
Clinical Knowledge
Although experienced in clinical practice, a medical director soon finds that
he or she needs a wider knowledge of medicine than that obtained in the usual
practice of medicine. Many of the decisions made by medical directors require
familiarity with specialized procedures and therapies.
Right now, for example, knowledge of the capabilities of PET scans and how they
can be used to deliver cost-effective care is essential, yet many medical directors
never ordered one during their clinical years. Healthcare organizations deal
with this by providing journals, conferences and desktop research capabilities.
Allowing and encouraging their medical directors to take time to go to clinical
seminars and interact with medical specialists also provides a means for them
to update their knowledge base. Little gains more respect from a network or group
of physicians than a knowledgeable medical director conversant about the latest
advances in medical care.
Business Acumen
Probably nothing frustrates healthcare organization CEOs more than a medical
director with a vast clinical knowledge, but no concept of the company's business.
Clinically based decisions almost always have a ripple effect throughout an organization.
A medical director who continually approves payment for out-of-network procedures
at a hospital, where its only claim to fame is better marketing, has not learned
that healthcare premiums are based on whether the HMO's network is open or closed.
The American Association of Health Plans, the American College of Physician Executives
and other professional organizations offer courses that train new medical directors
and raise their level of understanding of the healthcare industry. These courses,
plus weekly reading of trade magazines and other sources of industry information,
should be encouraged by CEOs to prevent frustration. Mentoring by experienced
and successful medical directors, whether in the organization or on a consulting
basis, provides the best way to keep them abreast of the changes and innovations
in healthcare.
Leadership Ability
To paraphrase a former and late leader of the U.S. House of Representatives, "Tip" O'Neil, "All
leadership is local." The ability to organize and lead a local and small
group of physicians often presages a physician who, with experience, can be the
leader his organization wishes. The same skills, then, can be applied to the
large network of physicians affiliated with an HMO or hospital.
Although some physicians are born with leadership capabilities and learn to use
them to lead successfully in a healthcare organization, even they need to hone
their skills in several areas. Dealing with difficult peers is an art in itself,
but, with the help of mentoring and formal training, this management technique
can be learned.
Probably most important and overlooked is the medical director's ability to speak
effectively, to motivate change or to explain it. Only a few are exceptional
in their ability to speak extemporaneously, but most can be taught to be concise,
logical and rational. Most formal courses for medical directors include public
speaking and they should be given every opportunity to speak to physician groups.
Rarely, does one see a medical director with all three skills -- clinical knowledge,
business acumen and leadership ability. But with support, mentoring and training,
most can become proficient in all. It is in the best interest of healthcare organizations
to provide the means for their medical directors to develop these skills to the
highest level possible.
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About the author: Paul Reich's career spans 23 years as a practicing physician
and nine years as a physician executive. As Chief Medical Officer for Scheur
Management Group (SMG), 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
with medical management programs. Dr. Reich is the project director and initiator
of SMG's MCORE: Managed Care Operations and Revenue Enhancement MCO assessment
survey program.
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Take the free MCO CHALLENGE survey to determine the health/fitness of your MCO
by selecting the survey from the "Pick Link" box at http://www.scheur.com .
Then decide if MCORE TM is right for you.
MCORE TM, the Managed Care Operations and Revenue Enhancement Review, includes
an intensive three day review of the operations/finance functions and work processes
of your MCO by leading healthcare experts.
- For MCOs who want a non-biased review of their operations
- For investors looking to appraise MCOs' operational and financial capabilities
- For businesses and associations wanting to assess an MCO before contracting
For more information, contact Dr. Paul Reich, Chief Medical Officer, at 617-969-7500
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Speaking Engagements:
September 9, 2001
NAHQ's 26th Annual Educational Conference
Reno NV
Topic: "Resuscitating Managed Care: Getting Off Life Support and Recovering
Credibility"
Speaker: Barry S. Scheur
October 12, 2001
ViPS interAct 2001 Conference
Monarch Hotel, Washington, D.C.
General Session: "e-Health"
Speaker: Barry S. Scheur
If you are interested in contracting either Barry Scheur or any SMG/VHPG associate
for your organization, please contact Nancy Belle at nbelle@scheur.com
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Sites and Sounds on the 'Net
SMG has no ownership of, nor does it endorse the following sites. This information
is presented as a resource for subscribers. In keeping with this issue's focus
on the successful transition from practicing physician to medical director, we
present the following sites that cover this area.
American Medical Directors Association at http://www.amda.com
Association of Medical Directors of Information Systems site at http://www.amdis.org
National Association of Managed Care Physicians is dedicated to physicians attaining
a vital role in healthcare. Visit http://www.namcp.com
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End of The Managed Care Insider eNews,
Volume Three, 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 Paul R. Reich, M.D. Editing and Research by Judith
Jaffe. Production Coordination by Nancy K. Belle.
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