Executives with white coats -- the work and world view of managed-care medical directors, part 2

Article Abstract:

Most managed-care medical directors spend a lot of time on quality improvement. Most managed care plans must do this in order to be accredited by the National Committee for Quality Assurance. Medical directors are also responsible for preparing budgets and assuring that they are followed. They must also maintain the network of doctors who participate in the plan, often visiting offices and evaluating the doctors' performance. In addition, many act as the public spokesperson for the plan. Many medical directors must work under a conflict of interest between the needs of patients and the goals of the managed care company.

Management

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Primary Care Physicians Should Be Coordinators, Not Gatekeepers

Article Abstract:

Primary care physicians should abandon their role as gatekeepers, a role that doctors and patients alike are dissatisfied with. The gatekeeper role was created to control costs by reducing referrals to specialists. Research also shows that effort is needed to improve the treatment of chronic diseases. Primary care physicians could act as coordinators of care provided by specialists. However, the primary care physician would not authorize the referral to a specialist. Financial incentives may be needed to prevent both overreferral and underreferral to specialists.

Innovations, Practice, Physicians (General practice), General practitioners, Continuum of care

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Executives with white coats -- the work and world view of managed-care medical directors. (part 1)

Article Abstract:

Two doctors analyze the training and job duties of managed-care medical directors based on interviews with 50 medical directors. Most medical directors have many years of clinical practice and some have business training as well. Job duties vary depending on the managed care organization. However, most medical directors are involved in utilization review. Other duties include budgeting, maintaining the network of doctors, profiling doctors, deciding how they will be paid, and interfacing with patients and regulators.

Surveys

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