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E-CareManagement News

May 6, 1999

Physicians and Care Management:  
MBAs Practicing Medicine, or Doctors Controlling Their Own Destiny?

Nearly 7 out of 10 physicians consider themselves "anti-managed care", according to a recent study.

Physicians tend to equate the old model of managed care (managing costs rather than managing patient care) with overpaid MBAs who tell them how to practice medicine, squeeze them for discounts, and randomly throw them out of provider networks.

How do physicians feel about new approaches of care management? Shouldn't they be wildly supportive?  Studies are mounting that disease management, medical management, demand management, and case management improve patient outcomes, reduce hospitalizations, reduce emergency room visits, and increase patient satisfaction.  Care management approaches fit well with most physicians' self-image of "doctor as scientist" - "Show me the data, and I'll change the way I practice medicine".

The reality is that today doctors are mostly indifferent and often hostile to care management initiatives.

What's going on here?  Let's back up a step and examine two aspects of health care conventional wisdom:

Conventional Wisdom #1:  Today, physicians direct over 70% of medical costs. When we make presentations to audiences, Tom often asks the question "What is the SINGLE most expensive medical instrument?"  While some in the audience mull over whether they think the answer is an MRI or a CAT scanner, he blares out that the answer is "THIS PEN (holding up a pen) IN THE HANDS OF A DOCTOR." The logic here is that 70%+ of medical costs must be prescribed, i.e., authorized,  by a physician.  This includes hospital admissions, lab tests, imaging tests, drugs, etc.  (The 70%+ of costs DIRECTED by physicians should not be confused with the 20% of total medical costs that go TO physicians for their services. HCFA,
1998)  In short, today physicians are the quarterbacks of the
medical team - they call the plays.

Conventional Wisdom #2:  Tomorrow's evolving vision of the health care system is "a seamless, integrated system of patient care" in which patients flow to the right provider, at the right time, for the right treatment, in the right setting, for the right price. This vision of seamless care management is enabled by data and technologies --  information systems, medical call centers, the Internet, WebTVs, hand held devices to capture patient information, etc.

So .consider these two aspects of conventional wisdom in tandem:
(1) Today's power of the doctor's pen, and (2) Tomorrow's seamless, integrated system of care.  How well do they fit together from the doctor's point of view?  NOT AT ALL!  Physicians are at risk of being disintermediated, or in plain old English (POE) they stand to lose their role as quarterback of the team! We shouldn't be surprised that they don't want that to happen.

We want to introduce the concept of a moment of truth in the doctor/patient relationship. The moment of truth for care management initiatives (and many other programs) often occurs in the privacy of the doctor's exam room.  Here's a common scenario:

"Doctor Jones, I've been offered an opportunity to participate in a diabetes disease management program through my ______(employer, HMO, pharmaceutical company, hospital).  They say they do a great job. What do you think?"

This is the moment of truth.  This is the moment at which many offerings will either sprout and thrive, or die unnoticed.  Will the doctor say "Great program, go for it," or will she say "Terrible idea, forget it."  Despite patients' mistrust of doctors in general, trust levels for "my doctor" remain very high.  In our experience, few care management programs have planned for this milestone moment.

There are 4 key motivational elements to getting doctors enthused about care management approaches.  These elements are:

(1)  Improved patient care.  "Will my patient get better care?" (This is necessary, but NOT SUFFICIENT to motivate most physicians.)
(2)  Aligned financial incentives.  "Will this program help or hurt my pocketbook?"
(3)  Convenience.  "How will this new program or system affect my day. Will it save or cost me time?"
(4)  Control.  "Can I continue to control my destiny? Will I retain autonomy?  Is all this another MBA telling me how to practice medicine?"

Doctors could look at care management as an opportunity to guarantee their role in the next generation of health care.  Will physicians seize the day?  We are aware of a few physician organizations that are developing this mindset!

That's your food for thought for now.  In coming months we will devote an occasional issue to each of these four elements and share examples of organizations that have done a great job at one or more. Can you guess which one just about everybody gets right? .the one that hardly anybody is paying attention to?


We have been working with a private investor funded company that has developed software to coordinate care for the highest cost patients. In a typical health plan, 1% of patients account for 30% of health care costs.  The software links case managers, physicians, and patients/families, thereby saving 8-15% of medical costs.


Wired for Health and Well-Being: The Emergence of Interactive Health Communication.  U.S. Government Printing Office, April 1999. Downloadable at SciPICH. While this 180 page report is oriented toward public policy issues, it contains a wealth of valuable information.

E-CareManagement News is an e-newsletter that tracks a major change in health care and managed care—the paradigm shift from “managing cost” to “managing care”.  This e-newsletter is brought to you by Better Health Technologies, LLC ( .  BHT provides consulting and business development services relating to disease management, demand management, and patient health information technologies.

You may copy, reprint or forward this newsletter to friends, colleagues or customers, as long as the use is not for resale or profit and the following copyright notice is included intact. Copyright © 1999, Better Health Technologies, LLC. All rights reserved.

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