reshaping Managed Care
nkb...@my-deja.com
Volume Two Number 1
January 10, 2000
PART ONE of TWO
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This issue of The Managed Care Insider eNews reflects passion, opinion,
and
views related to physicians, hospitals, health plans and health care
professionals working together to provide services and/or access to the
best possible health care for consumers. Much has been written lately
about
"provider relations" and the inclusion vs. exclusion of physicians in
the
management of patient care. In this issue, Insider eNews focuses on what
our new affiliate company, Venture Health Partnership Group (VHPG), is
doing to reshape the practice of managed care with increased provider
participation, and on a physician's view of the unrealized power
physicians
hold in managing care. We hope it provokes response, stimulates
discussion
and challenges change. As always, we welcome your comments to
ins...@scheur.com.
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Insider Vision: The First Born
By Barry S. Scheur
President, Scheur Management Group and Chairman, Venture Health
Partnership
Group
At the Scheur Management Group's recent annual meeting, we discussed our
new business initiative, Venture Health Partnership Group (VHPG), and
our
business strategy of acquiring eight to twelve HMOs within the next
twenty-four months and differentiating them through an orientation to
the
needs of local marketplaces and provider networks. In previous columns,
I
have portrayed VHPG's mission as "contrarian" in today's healthcare and
financial marketplace. I hope you will feel free to share your thoughts
on
our venture.
HMOs: A bad rap or the truth?
Managed care has come to symbolize irresponsible, bureaucratic,
non-customer-oriented or patient-focused health care, unfairness to
providers, rigidity and bureaucracy to consumers, and short-term
visions
of profitability. Many of these perceptions of managed care are true;
but
it doesn't need to be that way. VHPG's greatest challenge is to create
an
organization in Louisiana that will serve as our template -- what I call
the good healthcare template.
Why does VHPG think we can succeed when others have failed?
VHPG's vision, our objective, is to acquire distressed, provider-owned
HMOs, rolling them up under a national umbrella while operating and
marketing each entity locally. I believe we will be reshaping the
practice, and the future, of managed care, focusing on providing high
quality consumer-focused healthcare. We are becoming a new family, and
with the acquisition of our first HMO finalized (SMA Health Plan in
Louisiana), we have our first child. We will lavish love, affection and
guidance on it, and watch it grow and prosper.
We have the ability to differentiate VHPG from other investor-owned HMO
companies. We can do this because our goal is not to generate the
greatest
amount of profit possible since that will, in effect, blunt the
initiatives
we need to put in place to reshape a broken industry. We anticipate
that
we will generate reasonable return while we create and implement a
superior
HMO template, one that attests to the concept that there is a provider
and
customer equation that works for people and that will bring the
necessary
return on investment.
There is no question that we face economic challenges in effecting the
turnaround of financially distressed, provider-owned HMOs. But many of
these organizations are not broken medically; they are broken
administratively. VHPG will succeed by doing the following:
1. VHPG-provider partnership. The provider network is the HMO's
product.
Its reputation is the HMO's reputation. VHPG pledges fair provider
contracting, rewarding its partners who "get it" and participate as
responsible partners. This doesn't mean there won't be disagreements
with
providers or issues related to provider reimbursement. We will provide
information to providers and be responsive to their requests and needs.
We
will streamline bureaucratic processes and ensure accountability of our
employees. This has been the hallmark of SMG as a consulting and
operations management company since its inception. We will give
providers
the same stake in the provision of healthcare that they once had, and
make
it work under the new rules of the marketplace.
2. Customer-driven service. VHPG will put customer and provider
satisfaction before everything else we do. We emphasize the objectives
of
the original HMO legislation. We plan to initiate customer services
task
forces, including physicians and hospital managers as our advisors. We
will spend money on education, for both providers and members/customers.
Information is power; education will enable members to receive the
services
they need and assist them in achieving and maintaining good health.
3. Local control and decentralization. Although VHPG is a national
company, we are mindful of the perceptions of the local marketplace and
respectful of them, culturally and operationally. Our HMOs will remain
strong members of the community. VHPG does not plan to construct a
large
corporate infrastructure; each HMO will be a fully functional entity.
We
intend to support local decision-making. Medical management, provider
relations, customer service, contracting -- the essential business
functions -- will remain under local control and not be micro-managed
corporately. We will outsource non-core business functions where we can
identify partners with the requisite expertise, willing to take risk
jointly with us. VHPG will expend its resources judiciously, purchasing
from and offering value back to the community.
4. Fairness review process. VHPG will institute the nation's first
external fairness decision review process with a respected group of
bioethicists. We intend our decisions to be both medically and
ethically
appropriate. We will seek to assure our members and providers that all
appeals will be reviewed by this outside ethics panel. This is another
process to reshape the practice of managed care, the way it was meant to
be.
5. Brand identity. VHPG is acquiring provider-owned HMOs where the
identities of the HMO and the provider community are intertwined. VHPG
will strengthen this identity. SMG has succeeded with bold (and
sometimes
controversial) advertising, spending money to communicate the HMO's
message
and brand identity repetitively. It is this brand equity that customers
buy, reinforced by their perceptions and the (verbalized) experience of
members.
I believe passionately that community-oriented, locally marketed, and
provider-friendly HMOs are the key to the resurgence of managed care. I
am
putting my money where my mouth is, and I will share our progress with
Inside eNews readers.
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What's New at SMG?
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Up Close and Personal: Barry Scheur will be featured on MCO Executives.
Interviewed by Greg Loughlin, Barry's views can be found on the MCO
Executive site starting on January 10, 2000. To learn more, go to:
http://www.mcoexecutives.com
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SMG web site now offering access to amazon.com for all your book, audio,
video, music and computing needs!
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Upcoming Speaking Engagements:
February 3, 2000
2000 Health Care Forecast Conference
Graduate School of Management, University of California, Irvine
TOPIC: "Providers and Managed Care: Remedy for a Sick Business"
Speaker: Barry S. Scheur
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Sites and Sounds on the Net:
In keeping with our focus on relationships with physicians, providers,
customers, we present some sites that offer tips, strategies and
information related to improving all of these areas as well as
healthcare
sites which offer resources and research which may be useful to the
healthcare practitioner.
SMG takes no ownership of the following sites, nor does SMG endorse
these
sites which are presented solely as a resource for subscribers.
In 1997, the US Government sponsored a consortium to study the best
practices in customer service. To view the report, compiled by an
impressive list of companies and people, go to
http://www.npr.gov/library/papers/benchmrk/onestp.html
The Atlanta Business Journal article on Customer Service from November,
1999, can be found at
http://www.amcity.com/atlanta/stories/1999/11/01/smallb1.html
A site with information and resources for MCO Executives at
http://www.mcoexecutives.com NOTE: Barry Scheur is the featured
interviewee
on January 10th
National Practitioner Data Bank-Healthcare Integrity and Protection Bank
(NPDB-HIPB) to find out about backgrounds of physicians and other
healthcare professionals at http://www.npdb-hipdb.com
Looking for a medical conference? Try http://www.medicalconferences.com
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End of PART ONE of TWO, The Managed Care Insider eNews,
Volume Two, Number 1.
Scheur Management Group (SMG) is one of the most experienced specialized
healthcare operations management and business revitalization consulting
firms in the country. Our expertise is in time-sensitive analyses,
strategic business and market planning, operational re-engineering, and
communications, as well as implementation of start-ups, expansions, and
new
products. The firm's clients cover the spectrum of insurers, managed
care
organizations, physician groups, integrated delivery systems, hospitals,
employers, governmental entities, vendors, and other providers.
Contributors to this edition are Barry Scheur and Dr. Paul Reich.
Editing
and Research by Judith Jaffe. Production Coordinator is The Gracefield
Group at http://www.gracefield.com/gg/index.html
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