Tools, not rules, attract physicians

In 2008, 87% of physicians had managed care contracts, according to the Center for Studying Health System Change (HSC) 2008 Health Tracking Physician Survey, funded by the Robert Wood Johnson Foundation. Compared with physicians with one or more managed care contracts, physicians without managed care contracts were more likely to have practiced for more than 20 years, work fewer than 40 hours per week, lack board certification, work in solo or two-physician practices, live in the western United States and report practicing in a "non-competitive" environment.

"Physicians still don't like managed care, but they continue to lose the ability to do anything about it," Heller says.

On a positive note, Heller tells Managed Healthcare Executive: "Managed care companies have become much more physician-friendly and physician-oriented. They have come to realize that it is cooperation and not competition that works best for both parties."

DOLLAR-DRIVEN DECISIONS

Physicians' clinical decisions determine how up to 90 cents of every healthcare dollar is spent, according to Cassil.

Paul Keckley, executive director, Deloitte Center for Health Solutions, believes that much attention is being paid to the emergent role of consumers as active participants in clinical decisions, and physicians remain the dominant influence on health expenditures and drive most costs directly, however, "the 90% is a bit high."

The managed care community needs to better understand physician concerns, according to Heller.

"Involve community physicians in the managed care plan's policy and operational matters," he says. "Participate in physician training opportunities at medical schools and hospitals; hire locally, and train and support local physician leadership."

Keckley says plans should be candid with physicians, using reliable facts and hard data to influence behavior.

"Physicians are generally frustrated and fearful about the future," he says. "They want to be respected. They want to be seen as professionals and be free of intrusion by managed care. That said, they respond to tools, not rules, and the most meaningful tools are those that help them make better judgments about patient care."