Managed care information needs: a summary perspective

The key to survival in managed care is management of financial risk. You need to know what is in your contract and what you are obligated to do for which population during which period. Information systems can be an enormous help in managing managed care contracts and the financial risks they entail, but poorly selected and configured information systems will do little good for the organization that licenses them. The most important activity of a physician executive who is moving his or her organization into managed care contracting is to lead the process to define the functional requirements for information the organization will need to manage managed care contracts successfully.     

Organizational politics: did you hear?

How do you define organizational politics? The underground system of communication, the grapevine, what's really going on in the organization, rumors, knowing who really has the power? However you define it, all sources agree you'd better not ignore it. According to one physician executive: "Organizational politics is how things really get done, who really has the power, how decisions get made. Things are not always what they appear to be on the organizational chart." Presented here are some thoughts about organizational politics from physician executives and their stories of when it helped or hurt their careers or prevented them from accomplishing something in their organizations.     

We are our brothers' keepers.

An essential element of leadership for the physician executive is working with impaired physicians, whether their handicap is temporary or long-term, to make them fully contributing members of the health care team. Physicians must not only make themselves and their immediate staffs sensitive to the problem and its solutions, but also instill a helping environment for the overall organization.     

Effects of role variables on job satisfaction

This study examines the effects of role variables on job satisfaction among physician and non-physician executives in hospital settings. Positive relationships were found for both groups between role variables and job satisfaction. The results indicate that role variables have a significant effect on stress, job satisfaction, and organizational commitment in the physician executive and the non-physician health care executive. On a theoretical level, this research allowed for an extended test of role theory, specifically as it applies to the management of health care. The implications of these findings for role theory and the physician executive are discussed. Since this study is of an exploratory nature, it offers new insights into the field of health care management, and the physician's role as the executive.     

What physician executives and health care organizations should expect from each other

Today, interest in defining the role of the physician executive and ensuring this individual is effectively integrated into the organization is high for good reason--the ranks of physician executives are growing. What attributes should health care organizations look for when hiring physician executives and what should they should expect of them once they are on the job? Physician executives should: (1) have demonstrated clinical and management skills; (2) have a comfort level with participatory decision-making; (3) have superb interpersonal skills; and (4) be a champion of the patient. Physician executives should expect the following support from their organizations: (1) varied roles and responsibilities; (2) mentoring by other senior executives; (3) lifelong learning opportunities; and (4) complete support of the management team.     

Physician leadership. An emerging leadership position

Demand is growing for Vice Presidents for Medical Management. This is a new physician executive position that enhances the ability of hospitals and health systems to more fully integrate delivery of care and thus attract managed care contracts. Located at a hospital, a health system's headquarters, or at a hospital's MSO, this position complements the traditional role of a hospital Vice President for Medical Affairs (or Medical Director), as well as the role generally played by the Medical Director in a managed care organization, linking them via a continuum of responsibilities. Compensation and prospects are high for qualified candidates.     

Physician executives: managers first, clinicians second

The literature is replete, many would say depressingly so, with accounts of the changes that are rocking the health care delivery system. The demands on the system's leadership increases with every change. And the future holds even more changes, with a level of uncertainty that will makes today's demands seem childplay. Physicians, especially physician executives, will surely be key factors in helping the system maintain its fundamental charge of high-quality patient care provided at reasonable cost, but what exactly is expected of them? One point is clear: While their clinical backgrounds will continue to arm them well for reaching the executive suites of health care organizations, physicians who hope to fully succeed in management will have to acquire and master a widening range of management skills. An indication of just how demanding the health care management job will be is provided in this report, based on interviews with physician executives and the people who seek and sell their services.     

Hold or fold?

This article examines some of the problems of the health care organizations we serve and that support us. While external problems can besiege an organization, the fundamental building block for success is to develop physician buy-in and a well-functioning team. The author describes how his IPA failed because the physicians in his organization didn't bond sufficiently, and for a sustained period, to carry out business operations. What are the warning signals that might help you decide whether to stay or move on? An IPA must have: (1) A clearly articulated vision of what success will look like, one that is accepted by its members; (2) effective leadership; (3) clear evidence of adaptability and flexibility; (4) financial stability; and (5) good data available to physicians. There can be other evidence of trouble you need to watch for. In some areas, hospitals and health plans are hostile to physician initiatives. Don't rely on politically motivated decisions--they are too easily changed. If you plan to be a leader for your physician organization, focus on creating or revising the internal architecture of the group.     

Serf or citizen: physician status and organizational structure

For more than a decade, dynamic changes in the health care industry have created new organizations for physicians. The major change for physicians has not been the organization itself, but the principles by which it is governed. This fundamental shift is studied with its impact on physicians, by analogy, becoming more like serfs or more like citizens. A review of the general organizational direction and results of non-physician health care organizations is made followed by the statistical trends of physician groups. Historical comparisons of non-health care industries are made with current organizational choices of physicians and physician groups. Observations of physician decisions are made identifying the direction they send physician status along the continuum from serf to citizen. Physicians are unknowingly making decisions regarding the principles by which they will be governed in new organizations. The choices they are making give them less autonomy and less opportunity to make future choices. The seductive invitation to spend less time in administrative matters and more time practicing medicine is a siren's call that will diminish the status of physicians and the autonomy by which medicine is practiced.     

Managed care's Achilles heel: ethical immaturity

How can physician executives determine the prevailing values in the managed care arena? What are the consequences when values statements are ignored during decision-making? These questions can be answered using a process called ethical reasoning, which is different and more productive than making moral judgments, such as "is managed care good or bad?" Failing to include ethical reasoning in executive offices and boardrooms is a form of ethical immaturity. It fuels public suspicion that managed care's goal may be maximizing profit at all costs, as opposed to seeking reasonable profit through provision of dependable and accessible health care services. One outcome of ethical reasoning is rediscovering the basic truth that running one's business on competitive rather than altruistic principles is ethical whenever greater efficiencies and economic growth enlarge the size of the pie for everyone. Reasonable self-interest is a perfectly acceptable reason to act ethically. The time has come for physician executives to develop a basic understanding of pragmatic ethics, and to appreciate the value of adding ethical reasoning to the decision-making process.     

Global view offers good news for physician executives

Do all physician executives have much "catching up" to do in relation to their non-MD colleagues? A comparison of the role of the physician executive versus the non-MD executive/administrator provides a big picture view and signals new opportunities for physicians in the evolving health care system. Physician executives have only recently become invested in the health care executive suite and are less wedded to old methods and "classic" ideas. They are more likely to be able to adapt to new circumstances, jettisoning traditional approaches that have outlived their usefulness. But each group-physician executives and their MHA- or MBA-credentialed, non-MD colleagues- has much to offer to or learn from the other. By retaining those skills that are applicable, while also adapting the useful characteristics of the "traditional" health care administrator, a physician executive can increase the likelihood of success today.     

The new breed

Structural changes within the health system--particularly in the organization and financing of services--have made new and different opportunities available to physicians interested in management. What types of physicians are currently going into management? How do they compare to others who have been in management for a longer period of time and to the "traditional" portrait of the physician executive? The author profiles the emerging, contemporary physician executive and explores the implications for the viability of the field of medical management as a whole.     

Is it our turn to be CEO yet?

Physician executives continue to have ambitions for the health care CEO role, despite the difficult economic times. And though few have yet been chosen for the position, the expectation is that this will change markedly in the next five to seven years. Today, physician executives have legitimate, relevant professional experiences that directly qualify them for CEO roles in health initiatives. And no executive is more qualified to deal with medical care management issues than the physician executive. Key elements of preparedness are: Executive thinking, bundling projects, and learning to manage managers. The opportunities will be open to those who are ready to take them on.     

The physician executive and the future.

In summary, physician managers have a bright future. They are working on one of the most exciting professional interfaces--medicine and management. The future of medicine is both high-tech and low-tech. It will challenge all physician executives. For a few years, health care organizations will experience turbulence and stress. The name of the game for physician managers will be organizational survival. The nation will then move into an era of abundance in medical care, and the management game will switch from survival to thrival. Managers are key players in the world of tomorrow. The physician executive is a manager and therefore a key player. One of the best things about the future of the physician is that he has one.     

Health care applications of complexity science. Life at the edge of chaos

The authors explore complexity science, a relatively new field of inquiry, which holds for both clinicians and health care leaders the real possibility of stimulating fresh insights and approaches to health and medical care-both its provision and its organization. Two case studies are presented to illustrate how complexity theory can provide health care leaders with a new perspective on how to address the myriad challenges they confront daily: (1) a patient with dissociative identity disorder; and (2) a physician task group charged to advise on hospital medical staff reorganization and governance. These case studies help clinicians and leaders of health care organizations understand how complexity: (1) may be relevant, even helpful, as they consider difficult challenges in both patient and organizational management; and (2) might emerge as a synthesizing force as they face the extraordinarily complicated task of jointly creating integrated health care systems. A resource section is provided for those who may wish to further pursue the topic.     

Making a match: inexperienced physician executives and the job market

Hospitals and other health care organizations are adding physician executives at such a rate that demand is outstripping supply-there are more opportunities for seasoned physician executives than there are physicians with track records as medical managers. It is possible that hiring management will have to consider the employment of a physician who wants to be in management but has no track record as a physician executive. In some cases, it may even be preferable to employ a neophyte physician executive, especially when the physician is a respected clinician already on the organization's medical staff. In selecting such a physician, however, an evaluation must be made of the probability that the physician will be successful in the new role. The author points to 10 criteria that the hiring organization should observe in hiring inexperienced managers.     

Congratulations ... you're fired!

Being fired as a physician executive is the dark side of burgeoning opportunities for health care leadership. The risk of termination is 20 to 40 times higher than for clinicians. Several approaches to calculating and predicting the probability of being fired are presented, based on a recent survey of American College of Physician Executives members and the author's professional observations. The survey identified several factors that are associated with a higher risk of being fired. These include structural conditions like organizational type and position, as well as factors ranging from being the first person in a new or unclear job to working for an entity with two or more years of significant financial losses. Persistent conflict with a boss or board member--concerning personal style or organizational strategy--is another commonly present danger signal. Additional predictive variables include recent termination or departure of a boss, recent merger, and widespread organizational downsizing or re-engineering. This article suggests strategies to better predict high-risk situations, to prevent termination, and to increase the likelihood of your professional and personal well-being when termination becomes inevitable.     

Ascendancy of primary care will create role intensification for physician executives

The need for physicians in management roles in the health care system has never been greater. And the years ahead will see that need broadened and intensified. To maintain their leadership role in medical affairs in hospitals and other types of health care delivery organizations, physician executives will have to envision provider organizations and systems that have not yet been conceived, let alone developed and implemented. They have to become totally open-minded and futuristic in their thinking. And they will have to help other physicians accommodate this new way of thinking if the medical profession is to continue in a leading role in health care matters. Although numerous factors will have to be anticipated and analyzed by these new physician leaders, the ascendancy of primary care in a managed health care world long dominated by the technical and technological superiority of hospital care will present a particular challenge to the physician executive.     

Behavioral quality assurance: a transforming experience

The captains of the health care industry are leading a transformation in health care. Increasing numbers of physician executives are acquiring the knowledge, skills, and attitudes essential to both the science and the art of management. If they wish to practice the art of management at a high professional level, however, physician executives must be willing to experiment with their behavior in interactions. Change and growth in this aspect of human nature will also bring them face-to-face with their self-images. More important, attention throughout an organization to behavior toward one another will have a significant bearing on the quality of the organization's services to clients.     

Strategic positioning. Part 1: The sources of value under managed care

Part 1 of this series organizes and discusses the sources of value against a background of an evolving managed care market. Part 2 will present, in more detail, the marketing and financial challenges to organizational positioning and performance across the four stages of managed care. What are the basic principles or tenets of value and how do they apply to the health care industry? Why is strategic positioning so important to health care organizations struggling in a managed care environment and what are the sources of value? Service motivated employees and the systems that educate them represent a stronger competitive advantage than having assets and technology that are available to anyone. As the health care marketplace evolves, organizations must develop a strategic position that will provide such value and for which the customer will be willing to pay.