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."
