Dealing with managed care is new MD curriculum
Dealing with managed care is new MD curriculum
It's all about quality care
Despite the fact that 130 million Americans receive health insurance through managed care contracts, the nation's medical schools have focused very little on teaching physician residents how to work in a managed care environment. And physicians who already are working in hospitals and private practice settings also have lacked training in how to adjust their work to cope with managed care companies.
A movement is under way to change all this, and it involves some of the most influential medical colleges and health care insurance companies in the nation.
In July 1996, the Philadelphia-based Pew Charitable Trusts awarded a three-year grant of $8.3 million to Harvard Pilgrim Health Care to oversee a project called the Partnerships for Quality Education (PQE).
The PQE project has several goals, including:
· ensuring that residents are prepared to practice effectively in managed care environments;
· training medical students in managed care concepts and practices;
· identifying and developing community practices as training sites;
· training faculty in the skills and competencies of managed health care;
· initiating advancements in primary care medical education.
Physician's Managed Care Report asked David B. Nash, MD, MBA, FACP, who is the associate director of PQE, to discuss the project. Nash also is director of health policy and clinical outcomes at Thomas Jefferson University Hospital, and associate dean for health policy at Jefferson Medical College in Philadelphia.
Here are Nash's views on the project, and on teaching physicians about managed care practices:
PMCR: What is the Partnerships for Quality Education project all about?
Nash: It brings together leading academic facilities and managed care companies at 60 locations around the country to train the doctors of tomorrow. Several thousand medical students will go through the program.
The leading managed care companies and some of the most prominent medical schools are involved in this program. It's been going on for one and a half years and was in the planning stages for a year prior to that.
In February 1995, we had an inaugural meeting at which Carolyn Asbury from the Pew Charitable Trusts dreamt this up. One of my areas of research interest is managed care education. Also, our team at Jefferson does research and teaching in this area, so I got involved in the project.
PMCR: What is a key element of teaching physicians about managed care?
Nash: Practicing in managed care is no different from any high-quality practice. Physicians will need to focus on the cost-effectiveness of testing, focus on continuous improvement in medical practice, and focus on population-based care.
We believe the term "managed care" is a misnomer. It's about teaching physicians high-quality medical care for the future. Right now it's so important because if we don't prepare doctors to practice in this kind of environment, we'll have a disconnect in the marketplace. Right now we are not preparing our medical school graduates for a very different marketplace from the one in which their teachers practiced.
There is a lot of anxiety out there about managed care, and we're trying to allay that anxiety and impress upon people that we're trying to prepare doctors for the future. We don't have a particular stand - positive or negative - about managed care. We just want them to be good practitioners. So we tell physicians to get on the PQE Web site and learn about curriculum materials and books that are available.
PMCR: What surprises physicians and medical students the most about managed care education?
Nash: There is a concentration on cost-effective care or what we call evidence-based medicine. It means we want to make sure that most clinical decisions are based on good science. For example, how come only half of the patients who need beta blockers after a heart attack are getting them? It's a complicated question, and it has to do with changing doctor behavior and educating physicians who are already in practice. Medical practice is lagging behind what we all know to be good practice. Overutilization is rampant everywhere for everything.
Benchmarking is everywhere; integrated delivery systems have these systems, and benchmarking is readily available. But it's just not used as often as it ought to be.
PMCR: What needs to be changed in physicians' current mindset regarding managed care?
Nash: There has to be less slavish adherence to professional autonomy and a better understanding of accountability. That means proving you're worth doing business with. That's what I call the industrial revolution coming to medicine, and it is going on right now. It means we have to be professionals, and we have to be accountable for what we do.
Physicians must improve communication with patients and give patients more of a role in their own care. This better be done in the managed care environment, or we can't practice medicine. And this will bring better quality care to everyone.
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