|
Send this issue to a friend
PDF
You will need to install Adobe® Acrobat® Reader™ on your computer if you do not have it already.
Download Adobe® Acrobat® Reader™
|
|
|
Vol.2 . No. 5
|
November/December 2000 |
|
|
|
Insider Vision
Where Have All the Good Docs Gone? An Ode to a Needed New Breed of Medical Director
by Barry Scheur, President
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.
We need real physician leaders who are not satisfied with simply taking refuge behind the cloak of corporate policy, but who are given the authority and the encouragement to meet with, educate, and debate the medical community, and then implement policies governing administration, care delivery, reimbursement and quality of care.
Certainly, there is a need for physicians who analyze data and make utilization review determinations, but that is not the greatest responsibility for a medical executive in the new world of managed care. It is as a communicator, marketer, and standard setter!
Just about all community hospitals have hired vice presidents of medical affairs. While part of the management team, they are required to represent medical staff views to management, to serve as a conduit for information collection and dissemination, to balance the delicate areas of hospital and community politics. For all of the difficulties in making this role effective, this is a model that I think should be replicated, albeit with modifications, in the managed care industry. We need to accord physician leaders the respect and latitude they deserve as key members of the management team. The provider network is the product that is sold. The medical directors and their constituents, the physicians, are the key players in ensuring that the product we sell is indeed the product that the member gets.
To demonstrate how these new roles can be implemented successfully in health plans, for the benefit of multiple constituencies, Venture Health Partnership Group (VHPG), the company that Scheur Management Group founded to purchase and turn around failing HMOs, is redefining the jobs of our chief medical officers. We are mandating their focus change to reflect the challenges of the new millennium.
VHPG's chief physician executives will meet with employers and community leaders and explain to them, cutting through all the intellectualized verbiage, about treatment protocols and clinical relevance, why our health care plan works more effectively for members and physicians, as well as finding out what we need to do better.
We need passion, energy, eloquence, and boldness in physician leadership. And we need their acceptance as executives by both their constituent docs and the health plans they represent. Then we will provide them the necessary economic means and decision-making authority, given the responsibilities we are placing on them.
We think that the managed care industry may need to retrain current medical directors to fill this new role because that's what's needed to rebuild the reputation -- and the performance -- of our industry. |
Back to The Insider Index
|
|
|
