As the decade draws to a close, there is growing evidence that medical
education is responding more effectively to the reality of managed care in the lives of practicing physicians. Organizations that set direction for
academic medicine - such as the Association of American Medical Colleges
(AAMC), Accreditation Council for Graduate Medical Education (ACGME) and
Council on Graduate Medical Education (COGME) - are recommending the
addition of new curriculum components comprising many of the basic principles,
tools and techniques that underlie managed care.
These developments helped guide Tufts Health Care Institute (THCI)
during its recent review of its own core curriculum. Armed with research,
recommendations from national organizations and the experience of having
conducted more than 110 successful programs for an ever-expanding list
of learners, THCI staff, medical directors and medical advisors recently
came together to create a more defined, updated curriculum and set of
competencies. "The environment has changed a great deal since we began our work in 1995," says Rosalie Phillips, MPH, the Institute's executive director. "We must respond to the new requirements for training as well as update our content so that it remains compelling and practical and improves performance for our clients."
| "By learning to do managed care the right way, we can go
a long way in fixing the system we have"
- Harris Berman, M.D.
|
Curriculum Categories
The content of THCI's core curriculum addresses three main categories:
1) caring for enrolled populations as well as serving individual patients;
2) delivering care that is both high-quality and cost-effective; and 3)
managing the practice to achieve internal efficiencies and improve external
relationships with payers and regulators, among others. "This framework," says Phillips, "will lead to an array of new education solutions for our clients."
According to Ralph Halpern, THCI associate director for content
development and program evaluation, "Managed care competencies increasingly
are regarded as core competencies that are necessary for all practitioners.
There is a deepening recognition that the health care system must address costs
as well as quality, for individuals as well as patient populations. This
requires education in areas that were not part of the traditional curriculum."
When physicians receive up-to-date training and are supported by the
necessary infrastructure, they are able to practice "good managed care,"
according to Harris Berman, MD, chairman and chief executive officer of Tufts
Health Plan and THCI board co-chairman. "The need for THCI's current
curriculum cannot be overstated. The Institute has done a good job of helping
doctors see the advantages in managing care well and demonstrating that
their patients can benefit from this approach to practicing medicine."
Keeping the Curriculum Compelling
Still, convincing physicians to embrace the tenets of good managed care
remains a challenge, as is building the curriculum to teach those tenets.
"Because curricula are already full, time is scarce and faculty may not
be experts in these topics, they look for the ready-made, high-quality
courses and materials that we produce and continually update," says Halpern.
"We need to teach our students how to provide
high quality,
cost-effective care and how to practice
preventive medicine."
— John T. Harrington, MD
 |
|
 |
Harris Berman, MD
Chairman and Chief Executive Officer,
Tufts Health Plan and
THCI Board Co-Chairman
| |
John T. Harrington, MD
Dean,
Tufts University School of Medicine and
THCI Board Co-Chairman
|
John T. Harrington, MD, dean of Tufts University School of Medicine and
THCI board co-chairman, believes that medical students need to understand
the context in which they will practice. "We need to teach our students
the underlying principles of managed care, including how to provide high
quality, cost-effective care and how to practice preventive medicine,"
says Harrington.
"Much of the turmoil we see in the marketplace has to do with
misconceptions as to what managed care is," adds Berman. "By learning to do
managed care the right way, we can go a long way in fixing the system we have."
That's an ambitious goal, says Phillips. "But our staff and medical directors
are optimistic that, post-retreat, the Institute's products and programs will
be more useful and relevant than ever. This is important because, while
their training remains clinically focused, physicians must also contend with
continuous change in the health care system."
Tufts Health Care
Institute's New Curriculum Framework
A. Individuals and panels
1. Population-based care
a. organizational and financial considerations
b. health improvement strategies
2. Ethics
B. Quality care and cost
containment
3. Quality measurement,
improvement and oversight
4. Utilization management processes and tools
5. Clinical care strategies
6. Physician-patient communication
C. Practice management
7. Reimbursement and financial
operations
8. External relationships and marketplace regulation
9. Practice structures for customer service
10.Teamwork
11.Leadership and change
management
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