Managed Care

 

You Are Not Alone, Clinical Executive

MANAGED CARE February 2012. © MediMedia USA

You Are Not Alone, Clinical Executive

The Medical Directors Forum offers an opportunity for discussions with peers and a resource for information about guidelines
MANAGED CARE February 2012. ©MediMedia USA

The Medical Directors Forum offers an opportunity for discussions with peers and a resource for information about guidelines

Find the forum at: MedicalDirectorsForum.com

Think of the Medical Directors Forum as a gathering of baseball players from opposing teams who want to discuss the art of hitting. They are not revealing what strategies their teams might use to compete against each other in the field. They are talking about their livelihoods, the thing they love to do. It’s the sort of dialogue that medical directors for health insurance plans have missed, says Steven R. Peskin, MD, MBA, chief medical officer at MediMedia USA, the owner of MANAGED CARE magazine, which introduced the Medical Directors Forum last month.

Of course, one of the first questions addressed when such an effort is launched is: Will the targeted audience have the time to participate? “Focus groups said to us there’s a huge unmet need,” says Peskin, “and that unmet need is for a place that is very specific and focused on the interests and issues of medical directors.”

Secure place

Until now, there has not been a community on the Web that deals with the specific concerns of medical directors. “What the medical directors were extremely interested in was peer-to-peer interaction. They did not want to go looking for that on broad sites like LinkedIn or Twitter.”

There will be restricted access to the Medical Directors Forum, which was launched January 25, and all potential members will be screened by the moderators to ensure that they are who they say they are. Beyond that, the forum will be self-monitoring.

“If we hear that there are things that need to be blocked or feedback that must be curtailed in a certain fashion, then the steering committee will look at that.”

Besides Peskin, the steering committee consists of Maria Lopes, MD, of AMC Health, a subsidiary of Geisinger Health System; Albert Tzeel, MD, the medical director at HumanaOne, and Roger Muller, MD, the medical director in the Pacific Northwest for UnitedHealth Group.

Maria Lopes, MD, of AMC Health, discussion leader for the chronic conditions group.

Tzeel says that “the forum is a very good vehicle for medical directors from diverse organizations to really work together to improve the health of all our populations, which is the main goal of what doctors want to do in general.”

Lopes says that the Medical Directors Forum “provides a rich and ongoing dialogue about so many of the things that we do from a day-to-day perspective, but that all of us could do better if we were able to communicate with peers.”

Peskin says that the discussion boards will be one of the main draws. “They will focus on, for instance, patient-centered medical homes or accountable care organizations or quality improvement or credentialing or accreditation. Just to use those as examples.”

Albert Tzeel, MD, of HumanaOne, discussion leader for value-based design.

Two are up and running; one on chronic condition management is moderated by Lopes, and one on value-based design is moderated by Tzeel. “We really expect there to be many other interest groups where there will be a thought leader who will help to moderate and lead,” says Peskin.

Tzeel says that value-based design operates on the premise that “if you increase the cost burdens, you hopefully promote adherence. You also need the educational aspects that get an individual engaged to make changes that are necessary to keep him or her healthy.”

Lopes points out that her company’s parent company, Geisinger, has a history of letting others know about effective management techniques that it has developed.

“A lot of what I do is think about innovation, health information technology, how to improve efficiency and care coordination, motivating patients to do more of what we want them to do,” says Lopes. “I think about telehealth in the home so that physicians and clinicians have a better sense of what’s happening with patients between office visits and hopefully can adjust treatment regimens, prevent hospitalization, reduce costs.”

Efforts to reform health care make the launch of the Medical Directors Forum timely. “Health care reform will hopefully lead to better outcomes rather than a system that rewards physicians based on transactions for pay-per-service,” says Lopes. “When you focus on care coordination and health information technology with the electronic medical record across an entire system, you are able to control your network of providers and align incentives accordingly. It’s no surprise that integrated delivery systems come to mind.” Geisinger is such a system.

Reference library

The forum offers more than good conversation, though, says Peskin.

“We’ve created a reference library that pulls together all of the government guidelines — for example, from the Centers for Medicare & Medicaid Services and the Centers for Disease Control and Prevention — as well as from health plans such as Aetna, Cigna, UnitedHealthcare, and Humana,” says Peskin. “These guidelines are available in the public domain, but they are scattered. We pulled them together so if a busy physician executive is looking for information on coverage policies or clinical guidelines, she or he can immediately go to the Medical Directors Forum.”

The forum is aimed specifically at medical directors employed by commercial insurers, but is not limited to that category.

“The primary focus on the Medical Directors Forum in its inception has been for medical directors from health plans,” says Peskin. “That said, we see the Medical Directors Forum as a meeting place for medical directors at integrated delivery networks, group practices, hospitals and health systems, PBMs, and managed behavioral health as well.”

“There will be layers of communication whereby you can, for example, make a presentation that you are proud of available to anyone within the forum.”

Lopes says, “We always hope to learn from others in terms of best practices — what works, what doesn’t work. This site is going to be about content. It’s going to aggregate information and the ability to network. There is great promise in terms of what this can do and hopefully what it will do.”

Meetings

4th Partnering With ACOs Summit Los Angeles, CA October 27–28, 2014
PCMH & Shared Savings ACO Leadership Summit Nashville, TN November 3–4, 2014
2014 Annual HEDIS® and Star Ratings Symposium Nashville, TN November 3–4, 2014
Medicare Risk Adjustment, Revenue Management, & Star Ratings Fort Lauderdale, FL November 12–14, 2014
World Orphan Drug Congress Europe 2014 Brussels, Belgium November 12–14, 2014
Healthcare Chief Medical Officer Forum Alexandria, VA November 13–14, 2014
Home Care Leadership Summit Atlanta, GA November 17–18, 2014
HealthIMPACT Southeast Tampa, FL January 23, 2015