Saturday, April 10, 2010

MD/MBA Careers: Government Payors

Here at the Association of MD/MBA Programs (AMMP) 8th Annual Conference, Richard Kalish, MD, MPH (Medical Director of Boston HealthNet) spoke about his non-traditional career path to becoming a physician. He worked in the consulting industry before attending medical school. After completing a residency in internal medicine, he pursued a general medicine fellowship that included health services research and an MPH.

Here's his quote: "Find work you love, and you will never work a single day in your life."  Confucius

From 1996 to 2001, he was a medical director for the South Boston Community Health Center. He enjoyed working with data and wanted to find ways to reduce health care waste. From 1998 to the present, he been serving as the medical director for Boston HealthNet which includes 15 community health centers, the Boston Medical Center, and the BU School of Medicine. He's been dealing with decisions about electronic health records, interactions with community physicians, and . From 2001 to the present, he has been serving as the medical director for Boston Medical Center HealthNet Plan. Now, he deals with Medicaid, Commonwealth Care, and he leverages managed care organizations with community health to develop pay-for-performance plans and quality initiatives. He continues to stay involved with the BU School of Medicine in research and medicine. The entire time through his career. Dr. Kalish has maintained a primary care practice.

So, what type of careers can physicians find in Medicaid Managed Care Organizations (MCOs)? You'll need to work well with disadvantaged populations, safety net providers, and the government. You'll get to use multiple skills and work at the intersection between management and policy.

So, what do you do in a typical day/month?
  • Quality reports to the state
  • Internal QI (quality improvement) activities (NCQA ratings)
  • Network management
  • Credentialing
  • Cost savings initiatives (dealing with payment cuts from the state)
  • Prior authorization
  • Find the intersection of quality and efficiency
Community health centers
  • Over 20 million with limited financial resources
  • Directed by boards with majority consumer membership
  • Majority of revenue from third party payers
Medical director responsibilities in community health centers:
  • QI
  • Productivity
  • Health IT
  • Programmatic managemnet
  • Line management
  • Credentialing
  • Operations (clinical and non-clinical)
  • Financials
  • Clinical sessions
  • Be open to new ideas
  • Find a path that gives you passion and fullfillment
  • Develop new skills constantly

Make sure to return in a few weeks to find a hyperlink to Dr. Kalish's slide presentation.

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