Managed Care

 

Consolidate, Disseminate Clinical Practice Guidelines

MANAGED CARE September 1998. © MediMedia USA
Editor's Memo

Consolidate, Disseminate Clinical Practice Guidelines

John A. Marcille
MANAGED CARE September 1998. ©1998 Stezzi Communications

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.

Meetings

Private Health Insurance Exchanges Conference Washington, D.C. October 7–8, 2014
National Healthcare Facility Management Summit Palm Beach, FL October 16–17, 2014
National Healthcare CFO Summit Las Vegas, NV October 19–21, 2014
National Healthcare CXO Summit Las Vegas, NV October 19–21, 2014
Innovative Member Engagement Operations For Health Plans Las Vegas, NV October 20–21, 2014
4th Partnering With ACOs Summit Los Angeles, CA October 27–28, 2014
2014 Annual HEDIS® and Star Ratings Symposium Nashville, TN November 3–4, 2014
PCMH & Shared Savings ACO Leadership Summit Nashville, TN November 3–4, 2014
World Orphan Drug Congress Europe 2014 Brussels, Belgium November 12–14, 2014
Medicare Risk Adjustment, Revenue Management, & Star Ratings Fort Lauderdale, FL 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