Wednesday, January 11, 2012

Managed Care Insurer Medical Directors: A Recruiting Opportunity for Provider Organizations That Are Taking Insurance Risk

The investigative Disease Management Care Blog went dumpster diving outside the headquarters of a large health care organization and found this document:


To: The Health System CEO

From:  The Front Line Docs

Re: Physician "Accountability" Leadership

Thank you for taking the time out of your busy schedule to meet with the medical staff last night.  Since you arrived here a year ago, we physicians have been looking forward to our quarterly meetings and appreciate that you were able to make it this time. Thank you also for arranging the hospital cafeteria to supply the sandwiches. They and the boxed raisins were delicious!

"The white coats," as you refer to us, are very interested in your vision of the insurer-contracting opportunities around efficiency, cost reductions, "accountability" and "shared savings."  Like you, we are also concerned about unnecessary health care "waste" and "variation," and endorse your call to action, or rather inaction. The health insurers' statististics that were reproduced in your presentation on the frequency of surgical procedures at our institution was very eye-opening. As a result, we've already started to let our patients know that, when a trip to the operating room cannot be justified, we'll do everything we can to achieve maximum cost-effectiveness with alternative evidence-based care pathways.

In light of the above, may I recommend that you strongly consider hiring a physician-leader with the skill-set necessary to spearhead these program initiatives. While the current Vice-President for Medical Affairs has many of the fine qualities we've come to expect of your hand-picked appointees, let's face it: he wouldn't know a PMPM if he personally passed one into a bedpan.

In my opinion, attributes of a such a physician leader should include:

1. A strong grasp of clinical and health economic outcomes, trending and statistical analysis.

2. A fundamental understanding of health insurance contracting.

3. A track record of interacting constructively with physicians, hospital administrators and community organizations.  In particular, he or should she be adept at handling many of the hostile questions you faced last night.  That way, you can "outsource" the anger management.

4. An ongoing commitment to patient care, including taking "call" with the rest of us. 

I would like to point out that such physicians can be found among the Medical Directors that work in many of the nation's commercial health insurers.  While every commercial insurance plan has a senior-level ("Vice President") medical director, each if these executives usually has several medical directors reporting to him or her.  Since these individuals work in very hierarchical organizations with little chance of advancement, many would jump at the chance to deploy their skills in a risk-bearing provider organization like ours.  An enterprising head-hunter recruiter should have little trouble poaching some of these highly skilled docs who possess precisely the kind of talent we need.

Once again, thank you for your time and I look forward to working with you in the future.

Sincerely yours,


There was a also hand written note appended at the bottom:

By the way, I've booked the MRI you requested and set up the appointment with the specialist.  As we discussed, better safe than sorry!

1 comment:

GlassHospital said...

this is masterful.

only topped by gawker's "tim tebow: why all the fuss?" for non-sports fans.