FORT LAUDERDALE, Fla--"The best way to reduce health care cost
is to improve health care quality," said Lee N. Newcomer, MD, MS,
in his keynote address at the Second Annual Conference of the National
Cancer Center Network (NCCN). And managed care organizations are attempting
to do this via measuring and improving the performance of physicians in
its networks, he added.
Dr. Newcomer is chief medical officer of United Healthcare, a managed
care provider based in Minneapolis.
Measurable performance data are the only means to demonstrate value
objectively, he said, and the ability to demonstrate value is what distinguishes
one physician and one hospital from another.
"The people who run managed care organizations are looking for
physicians and hospitals that will add value," he said, "We want
to know what's different about what you do so that I can say we should
have you in this network rather than the physician down the street."
Managed care organizations seek value from their network physicians
and hospitals, and work to offer the same in return, he said.
United Healthcare, for example, does more than just pay claims. It adds
value to its network physicians and hospitals by improving quality to reduce
cost, developing information systems to identify quality issues, and sharing
that information with providers and hospitals.
He also suggested three ways oncolo-gists can add value to their services:
Act as the patient's personal care physician. Managed care organizations
are finding that "the type of treatment you get is directly related
to which doctor you see first," he said. "If you are dealing
with a cancer that has three options, you will likely get surgery if you
see a surgeon, radiation if you see a radiation oncologist, and chemotherapy
if you see the oncologist." He believes that oncologists must remain
the general consultant for oncology, and direct when to treat, how to treat,
and when to offer supportive and palliative or hospice care.
Additionally, he said, "you have to make chemotherapy a cost-neutral
equation, by avoiding excessive markups for medications. The industry is
probably going to do this for you."
Measure your performance. "Performance measurement is critical,"
he said. Although data collection is not simple and yields no financial
reward, "I think it is your key to staying in business even two to
five years from now."
Improve your performance and document those improvements. The
point of measuring a physician's performance is not to criticize it but
rather to help the physician improve, he said. Managed care organizations
will be generating practice data for their physicians, but physicians should
also generate their own data.
"Not only will measuring your performance provide you with objective
data, it will improve your skills as a physician, enabling you to go from
a good physician to a superb physician," he said.
He emphasized that physicians and hospitals can demonstrate their value
by documenting quality performance that may lead to improved care and reduced
cost, and showing that data to managed care organizations.
Reducing cost by improving quality includes eliminating waste and reducing
variation, he said. For example, approximately $90,000 was billed to United
Healthcare in 1996 for tine tests for tuberculosis in children even though
three years earlier, the American Academy of Pediatrics issued a policy
statement that such tests were ineffective in children.
Dr. Newcomer believes that sharing such findings with providers and
hospitals will enable clinicians to evaluate the evidence, look at their
own performance, and, if necessary, improve their practice to comply with
evidence-based standards of care, while also helping to lower costs.
Micromanagement Not the Aim
Dr. Newcomer stressed that managed care plans do not want to micromanage
physicians' practices, but rather provide standards ("and it may be
the NCCN guidelines," he said) for physicians to follow in a way that
works best for them.
The plan, he said, will set the standards and set the rewards for meeting
those standards, "then get out of the way, so that you can achieve
those standards in your own way. That's what we call 'accountable autonomy.'"
The NCCN guidelines are a good beginning toward establishing evidence-based
standards, Dr. Newcomer said, adding that any guideline is only a recommendation
and does not replace good clinical judgment. "Each physician needs
to take responsibility for his or her own performance," he concluded.
"That is, know the standards, use them wisely, and measure your own
performance against established standards."