hello world

thanks for tuning in.  by way of introduction, i am a former practicing surgical sub-specialist.  after practicing 5+ years in an academic setting, a private two-person practice, an hmo staff model and an ipa - i found that there is no "perfect" practice.  the frustrations of working in the healthcare system, trying to help my patients were so great that i needed to find some way of fixing these systemic problems.  i realized that caring for patients one at a time would not enable me to change the system.  so i packed up my scalpels and left clinical practice and headed off to an illustrious career in health plan administration as a medical director/chief medical officer.  if you can't beat'em, join'em, right?  or so i thought.

guess what?  health plans are all screwed up also!  quelle supris!  while a chief medical officer (CMO) is supposed to oversee a health plan's clinical programs, including utilization management (the unit that approves/denies requests from providers for healthcare services that require authorizations), pharmacy (the unit that approves/denies requests from providers for drugs that require pre-authorization), quality (the unit that is supposed to assure quality healthcare services through auditing, credentialing and conducting quality studies and implementing quality improvement projects) and grievances & appeals, the reality is that the CMO is mostly a figurehead with very little ability to actually improve the healthcare delivery system.  in fact, after having worked in health plans for 5+ years, i have come to the realization that health plans are the cause of (not the solution to) our healthcare problems today.  [yes, i may be a little naive and polyannish - but hey, that's my midwestern upbringing]

of course, it's not their fault.  it's really no one's fault, right? - it's just the way the system was set-up.  [there is actually some truth to that - more to come in later posts]  health plans are in the business of keeping themselves in business.  self-preservation sustains the industrial inertia that keeps the status quo so firmly entrenched that it suffocates innovation in healthcare.

to be fair, self-preservation applies to just about everyone in healthcare and that's another reason why health "reform" is so hard.  physicians are doing their best trying to keep their heads above water.  hospitals are fighting just to stay open.  employers "victimized" by ever-increasing health plan premiums for their employees don't know any better and simply shift the costs to their employees.  and we, as consumers, are left holding the bag, powerless to change the way we're being treated by the healthcare "system."  finally, we now have government trying (again) to make some inroads into the healthcare mess.  we'll keep our fingers (and toes) crossed to see if anything substantive comes of it.

stay tuned for further posts.