Health reform puts healthcare organizations at more financial risk than ever for care costs and quality, both inside and outside their workplace. But it doesn't change the fundamental fact that physicians, even employed physicians, remain the final arbiters of what care actually is provided. CMO responsibilities evolve with need and business acumen grows as a vital need.
The Medical Director role takes on a dramatic evolutionary shift in responsibility and scope due to healthcare reform (and re-reform) and an industry which is now focused on efficiently driven quality care.
As healthcare continues to change, so do some of the roles within the industry, but no role has perhaps experienced a shift quite as significant as the Medical Director. This position has taken on a dramatic evolutionary shift in responsibility and scope. The roles and responsibilities now require stretching medical director skills into contract negotiations, group dynamics, organizational development, team management, and many areas not covered in a traditional medical curricula.
Many people who talk about managed care don’t realize that it has actually been undergoing a bit of a renaissance since the late 1980s - and has existed conceptually since the ‘30s. Since the late ‘80s, MCOs have progressed through several phases: Phase 1: Using utilization review and pre-admission certification to manage access to care. Phase 2: The addition of fee-for-service networks and managing benefits. Phase 3: Shift from utilization review to utilization management with an emphasis on the ‘appropriateness’ of care as well as the care setting. Phase 4: The current phase of MCO development, which has only started in the last couple of years, looks at establishing a continuum of services, lessening the tendency for providers to operate in ‘silos’ which has been the dominant structure of healthcare in the U.S. for years.
Historically, HMOs are notorious for incurring poor health among patients and bolstering already bloated administrative costs. When healthcare reform was on the horizon, the promise of Accountable Care Organizations in lieu of traditional HMOs lifted the wilted spirits of doctors and patients alike. A few years of ACOs, however, seems to have done little to assuage the initial fears of these groups that ACOs are just nicely dressed HMOs.
How will Medicaid work with the new exchange? What changes have occurred as a result of the ACA?
The Evolution of the Medical Director
As healthcare continues to change, so do some of the roles within the industry, but no role has perhaps experienced a shift quite as […]
Currently states are making the transition to Managed Care, or allowing Managed Care Organizations to take the lead in providing healthcare to Medicaid.
Many healthcare organizations are currently undergoing a transformation from fee for service to flat rate payments as they evolve into Managed Care Organizations, but the path to becoming a […]