John A. Marcille

John A. Marcille

Physicians are not only second-guessed by health plans that disagree with their decisions, but are bombarded with step-by-step rules for treating disease.

Highly trained and experienced, they should be excused if they resent it. Most probably don't, however, because advisory guidelines are important tools. This month's cover story finds wide agreement among physicians, as well as plans, that advances in medical science are unacceptably slow to trickle down to the trenches. Even assuming the profit motive, it is in the interest of managed care plans to promote the most effective medicine, and one way that many do it is by disseminating guidelines and other clinical information.

We expected to find examples both of positive and negative reinforcement, but we could find no plans that actually admitted to strong-arming doctors. Good. Plans should not be forcing physicians, but they can do a service to all the stakeholders — themselves, physicians, patients, employers — by encouraging physicians and giving them easy access to information.

One consortium of heath plans in Texas is pointing the way by agreeing on clinical guidelines, starting with diabetes. I like this idea because physicians would have only one guideline to consult, even if treating patients from a dozen health plans. And it also allows for local physician input — highly desirable.

That's one way to promote up-to-date practices. Another is to help physicians acquire computers and software that will allow them to easily and quickly consult guidelines and other current medical literature. Here, the fragmented managed care system works against itself, for what plan wants to subsidize a purchase that will aid its competitors? But an influential organization such as the American Association of Health Plans might, for example, marshal its members to pay a small amount to every practice — based on size of patient panel — for hardware/software purchases that could facilitate clinical, as well as administrative, efficiency. It's worth considering.