Care management challenge is the toughest yet. (Career Rx).

Sometimes health care trends jump out with vigor, and the next one is already here. All of the changes in health care have swirled around physicians, and, yes, physicians have absorbed changes in payment. information systems, and other Important areas. The newest strategy involves changing the core business--health care delivery and the resources Involved--through better care management. This impacts every practitioner all day, every day.

Expertise in care management was probably on the list of expectations for you in your current role--and It will certainly be high on the list for your next position. Health care systems are actively seeking physician executives with a strong track record of care management experience and expertise.

This issue truly belongs to the physicians, and thus to physician executives. Care management is the latest frontier, the place where the delivery of quality care, In the most efficient way, at the best possible cost, all come together. And physician executives are being challenged to make it happen, to change the way medicine is practiced and health care is delivered across the country, to move from treating episodes of care to a true preventive mindset and population-based methodologies.

It's a giant step that demands rigorous skills far beyond vague listings of "leadership" or "vision" that position specifications consistently call for. This Is what you could call "the heavy lifting." These challenges are so complex that they must be championed by a physician, and effective communication skills and team-building capabilities are critical attributes for those who hope for success.

Your assignment, and you cannot help but choose to accept it, is to marry finances and care delivery while tracking outcomes. With this is the imperative of using data to inform, interpret, educate, and re-acclimate in a way that impacts each physician, one by one. This will be the toughest job you will ever take on.

Swinging at every pitch...

Care management has many names, including clinical effectiveness, population-based management, disease management, resource management, quality improvement, reengineering--and probably a few more. All play a key role in care management. Tools include evidence-based practice guidelines, clinical pathways, disease management systems, best practices, case inbound and outbound call centers, nurse triage systems, and physician profiling--to name only a few. Reliable benchmarking and outcomes reporting systems are difficult to establish; just creating an infrastructure Is a challenge at the outset.

With cost as a driver, health care providers nationwide have been swinging at every pitch, first going after basic cost reduction, then the acquisition of group practices to lock in market share, and, most recently, consolidation and integration. Health care costs have not fallen. No strategy to date has done any better than keeping pace with inflation. Care management is the next attempt at achieving this elusive goal.

New skills required

To remain competitive, it's essential that systems-based physician executives develop or enhance skills in care management. Briefly, these are:

* a working knowledge of the various methodologies (e.g., disease management, quality improvement, reengineering, innovation)

* good facility with data analysis, interpretation, and explanation

* an appreciation of the critical aspects of good information technology

* an acknowledgment that care management is a team and a contact sport

* a commitment to the education and evangelism needed for success

* excellent communication, marketing, and persuasive skills.

Here are a few ideas to consider in the context of your continuing career development:

* If you don't know much about care management, get busy and learn a lot right away

The academic sphere and the intensivists from the ICU used to exist In a relatively isolated world in which to develop and explore their own models. Care management has left the theoretical and entered the practical, and courses and seminars are widely available. Approach studying the discipline the way Mayor Daley approached voting: "Do It early and do it often."

* Get motivated

This Is, as previously noted, an incredibly difficult initiative that will take years to accomplish. Make sure your energy and enthusiasm are fired up to a high level, as its easy to become discouraged. Zeal will come in handy.

* Stay creative and alert

No two organizations are the same, so each solution will require custom tailoring if It is to fit properly into a specific organizational system and culture. No boilerplate or off-the-shelf answers will work here, but having experience in a variety of situations will help you to respond creatively in this highly complex arena. This is one more place in which you'll need to think "outside the box."

* Be sure you have commitment from your CEO down through the organization

This work can only succeed when the organization, starting from the top, is completely on board, In addition, you'll want to have a culture of CQI that encourages information sharing, and a collegial culture where leadership is shared with physicians. An organization without a strong, effective physician executive will likely have a tough time effecting the kind of changes needed.

* Keep a long-term perspective and set realistic goals

The health care industry did not get where it is in a month or a year, and it will take a long time to see real change occur. Be in it for the long haul, ready to stick with it in the difficult times that lie ahead. Having realistic goals will help you-and the organization--stay on track.

Are we there yet?

Health care organizations must move past this last, giant hurdle if they are to achieve economies while improving quality. It will be your proudest achievement if you are successful in making inroads on the essential work of realigning physicians' and new health care systems goals. Care management in a climate of quality is a good place to start.

And failure is not an option. Your victory will be easily recognized by all--those organizations that have made the greatest progress will be the systems that will thrive. As for the rest, what will happen with organizations where physicians were not enrolled as part of the solution? Time will tell.

Mary Frances Lyons, MD, is a Senior Consultant with Witt/Kieffer, Ford, Hadelman & Lloyd in St. Louis. She can be reached at 8000 Maryland A venue, Suite 1080, St. Louis, Missouri, 63105 or by calling 314/862-1370. Please fax career development questions that you would like addressed in this column to Dr. Lyons at 314/727-5662.

Note

I am grateful to John Byrnes. MD, Vice President of Care Management at Catholic Health Care West in San Francisco, California. for his editorial insight and clarification on this column.