Tuesday, March 13, 2012

The Rise of the Medical Director: What One ACO's Good News Tells Us

Medical Directors prepare for battle
The VP of Finance finally agreed to a meeting. In order to make maximum use of their time, however, he had a simple request: submit an agenda of topics first and then he'd be happy to let his administrative assistant set up an appointment.

In that game of organizational politics, Finance VP: one. Senior VP and Medical Director: zero.

The lost voice mails. The patronizing glances. The unanswered emails. The skeptical grins. The condescending nods. Every lead doctor, medical director and physician VP is exquisitely familiar with the tut-tuting attitude that lingers just below the surface, ready to spring when their opinion on how to best serve patients bumps into the organization's budgeteers. Those finance guys know that the typical physician is used to spending dollars like a Miami-Dade ICU on a 98 year-old. They know those "white coats" are incapable of understanding costs, margins and cash flow. Better that they get out of the way and let the money experts call the shots, eh?

Call it the clinical-finance tension. Like government revenue vs. cutting taxes. Sales vs. customer service. The DMCB's premium cable TV preferences vs. the spouse's unreasonable penny-pinching.

Which is one of the reasons why the Disease Management Care Blog found this New York Times article interesting.  If this is any indication of what is going on nationwide in the delivery of medical services, the implication is that the physician leaders' perspectives are in the ascendancy in their organizations. Not only is there a pervading belief that keeping patients like Ms. Cline away from the emergency room is important for the bottom line, but that achieving clinical outcomes is no longer secondary to making budget.  While typical news reporters haven't picked up on the clinical-finance tension that lurks in health insurance and delivery organizations, the very fact that most of the NYT's interviewing involves physicians is telling.

The playing field is currently level.

Which brings up four points:

1. The DMCB suspects the genesis of the NYT article was this presentation at a recent AHIP meeting.  Thanks to reading the DMCB, you also know that a lot more background detail on the Advocate-BCBS Illinois collaboration is here.

2.  Abstracts, presentations and news articles are one thing, but having results reported in a peer-reviewed setting is another.  The DMCB readers know that they'll withhold final judgment until it sees some transparently presented hard numbers.

3.  While Medical Directors are currently playing on a level playing field, disappointing budget results, financial losses and failure to achieve savings could not only tilt things against the clinicians again, it'll quickly undo the merits of "doing the right thing."  That alone is a good reason to hope that the health system "accountability" arrangements like ACOs survive.

4.  The secret sauce to Advocate's success?  Care Coordinators.  More on that in tomorrow's post.

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