Athough managed care represents a major change from the way many cancer centers have traditionallydone business, it is
Athough managed care represents a major change from the way many cancer centers have traditionallydone business, it is "here to stay," says Patricia J. Goldsmith, vice president for managed care and business development at the H. Lee Moffitt Cancer Center and Research Institute in Tampa, Florida. Addressing the 24th Annual National Meeting of the Association of Community Cancer Centers, she added that Moffitts experience teaches that "we can prosper" if we "learn to live with it." In 3 years, Moffitt changed adversarial relationships with managed care companies, which accounted for a small percentage of its patients, into a rapidly growing economic mainstay, which will soon provide almost half of the centers business.
In 1995, Moffitt, which is Floridas only National Cancer Institute (NCI)-designated cancer center, had nine managed care contracts representing 16% of its business, Goldsmith noted. By 1998, 38 managed care contracts provide 40% of the business, a figure projected to reach 47% in 1999.
With an overall total 4,000 admissions per year to its 162 beds and over 115,000 outpatient visits in 1996, Moffitt has found the increasing numbers of patients flowing from managed care a key to its financial stability and prospects. In place of the "significant access issues" and hostility that used to discourage managed care patients from seeking care at the center, Moffitt has undergone a "big attitude change" as it successfully adapted to managed care without compromising its standards of care. And, Goldsmith believes, other centers can do the same.
Four Crucial Steps
She outlined four steps that proved crucial to the turn-around. First, Moffitt "built a managed care infrastructure" to effectively handle the plans bureaucratic requirements. Second, it "developed a managed care philosophy" that embraces both financial and patient-care concerns. The managed care department, she noted "reports to both clinical and financial" leadership. Third, it instituted "ongoing employee and physician education on managed care" issues and concerns. Fourth, it created "meaningful interaction between managed care and Moffitt leadership."
A basic lesson of this experience is that "educating and developing relationships is worth the effort," Goldsmith went on. Moffitt makes a practice of inviting case managers and other managed care officials for on-site orientations and tours of the centers facilities. It also brings educational programs to managed care officials at their regional meetings. Both strategies allow members of the two organizations to meet as human beings and forge personal ties.
Case managers are particularly crucial in the success of Moffitts relationship with a managed care company because they are "key drivers of where oncology care [patients] go, "she said. "The more that case managers understand oncology care" she added, "the less you are likely to be questioned" about treatments. In educating managed care officials, it is important to "show expertise in all areas" and that "physicians...be involved in negotiations" and tours. And, she added, key to developing successful relationships is a simple rule: "Always feed people." Breaking bread together greatly speeds up developing human relationships.
During negotiations, its important not to rush, and to first "sell your product"--the capabilities of your institution--and "then discuss price." Remember, she added, that each action or decision sets a precedent for the future.
Careful Documentation, Presentation of Data
Presenting a full view of a cancer center requires careful documentation in many areas, including case mix index, length of stays, outcomes, patient satisfaction, types of patients referred to you, and payment issues. Full justification of your costs and charges is very important "because managed care organizations are more used to negotiating with full-range community hospitals" than with cancer centers and are used to paying lower per diems and more flat rate outpatient payments than is customary at a cancer center. It is necessary to educate managed care companies on "why oncology care is different" from other types of care.
Through careful presentation of data, however, Goldsmith said, Moffitt succeeded in showing that, although its day rate was higher than that of community hospitals, its rate of intensive care unit bed days was lower than rates for comparable patients elsewhere, and therefore that Moffitt provided more cost-economical care. "Pharmaceuticals present a major issue for oncology," however, that "needs lots of education" for managed care organizations.
These strategies have resulted in "success stories" at Moffitt, including a large bone marrow transplant business, which used to be transferred to centers out of state, and very good outcomes data. A major local advertising campaign also informed the public about Moffitts staff and facilities and urged them to "make sure Moffitt is in your plan." This convinced local employers to ask that Moffitt be added to their employee plans and resulted in increased referrals, Goldsmith said.