Provider Behavior & Managed Health Care

Question 1

Principles to follow for changing physician practice behaviors (4) -F2015

Answer 1

1. ) Relationships matter - physicians acting as medical managers should get to know their practicing peers, and should approach conversations as a respectful colleague (not as punishing authority(
2. ) Let data speak for itself - performance data should be analyzed to see if variations from expected are result of sicker population or diff demographics. If variations not explained, then set up conversation with physician.
3. ) Peers are powerful influencer of physician practice patterns - more likely to change their behavior if they can discuss potential changes with a peer
4. ) Peer leaders must understand and communicate the big picture - be able to speak to org’s intent, answering questions as to why physicians are being managed

Question 2

Tools for changing physician behavior (3)

Answer 2

1. ) Ongoing communications: electronic/paper communication, group meetings, social media
2. ) Data - challenge is not getting info, but knowing which info can be translated into useful knowledge. Data must be checked for accuracy.
3. ) Mission clarity - widespread understanding of what the org is trying to accomplish is extremely valuable in changing behavior

Question 3

Programmatic approaches to changing physician behavior (5)

Answer 3

1. ) Financial incentives
2. ) Formal continuing medical education through seminars, conferences, and home-study. Studies found little evidence traditional continuing educatio changes behaviors.
3. ) Data and feedback
4. ) Practice guidelines and clinical protocols - using evidenced-based guidelines
5. ) Small group programs - strong evidence of positive changes resulting from educating physicians in interactive small groups

Question 4

Effective Data and feedback factors (6)

Answer 4

1. ) Goal alignment - physician must have reason to change
2. ) Clean data - must be credible
3. ) Knowledge - must be consistent and usable
4. ) Timeliness - closely related to what physician is doing at the time
5. ) Reinforced - must be regular to sustain changed behavior
6. ) Extrinsic motivation - link to economic performance

Question 5

Effective Evidence-based guidelines factors (4)

Answer 5

1. ) Efforts focused on 1 or 2 new guidelines at a time
2. ) Focus on conditions that occur frequently and with large practice variation
3. ) Implementation accompanied by regular feedback
4. ) Financial rewards used

Question 6

Stepwise approach for changing behavior in individual providers (4)

Answer 6

1. ) Collegial discussion of cases and utilization patterns in a non-threatening way
2. ) Persuading the provider to act in ways he or she may not initially choose
3. Firm direction (if first 2 steps don’t work) - reminding physician’s commitment to cooperate with organizational policies and procedures
4. ) Discipline and sanctions - occur for: poor quality care, failing to cooperate with plan policies and procedures (terminate “for cause”), utilization doesn’t match org’s managed care philosophy (terminate without case if adequate notice is given)