Q&A with Dr. Tom
My patients are being managed to death. With all the “care management,” “care coordination” and “managed care champion” programs at all levels—both at my organization and at the level of insurers—they’re getting fragmented, contradictory advice and they're checking out on everybody, even me. At the least, it’s undermining our relationship.
What can I do?
Call those managers and tell them to stop.
But be nice about it. At least at first.
These systems are created to make the insurance company money---and, depending on your compensation formula, you might actually get a share.
If the continual contacts annoy your patients, call up your insurer's provider relations line, ask them to back off, and tell them why. And maybe you’ll free up some of their time so they can help other patients who clinicians aren’t as engaged as you.
If they keep doing it, call again. But speak to the supervisor this time. Explain that their calls are resulting in more costs—-not less, and possible enrollment loss. Try to be nice again.
If it keeps up, you have a much more serious problem. Possibly a systemic problem.
Your employer and/or insurer may be executing a plan to supplant their Medicare Advantage primes in favor of a more industrial approach. An approach where you're a patient's prime in name only and the health system itself wants to be seen as the patient's "doctor".
If true, prepare to be marginalized, overworked and have your compensation cut. You're about to become an interchangeable cog in the factory of corp-med.
Allowing primes to control care-coordination with their patients is an excellent test as to how your sponsors view your role.
If you can’t push back within the organization, it may be time to find a better one—-there're plenty out there.
Because if you can’t push back with effect on something like this, bad things (compensation cuts, increased documentation demands, loss of local control) are coming your way.
I absolutely guarantee it.