Power Point Presentation made to a major pharmaceutical manufacturer in 1998. Identifies cause of Medical Crisis and how Pharm mfgrs can use regulations to add value to their contracts with MCOs.
24. The management of all employee benefits (medical, workers comp, EAP, disability, etc.) will be awarded to a single full service financially sound entity
25. Purchasers are willing to pay for quality & value for the employee - if the health plan has the lowest price
77. 12b. Remove barriers that rob people in management and delivery of care of their right to pride of workmanship. This means complete abolishment of the annual or merit rating and of management by objective, management by numbers
78. Deming believed that performance appraisals destroy teamwork and focus on the short term
79. People must be viewed as the most valuable resource a company possesses
80.
81.
82. Management should drive out fear and eliminate other inhibitors and barriers to quality improvement
83. Quality improvement must be proceeded first by education of employees on what quality means and the needs of the customers
256. Love - Hate relationship between the “Medical Management” and “Member Services” departments.
257. Member Services director reports to Claims V.P. reports to Sr. V.P. of Operations (where MIS usually reports)
258.
259.
260. Contract exclusions and limitations easy to administer -- “medical necessity” based on criteria and standards of care more difficult -- sometimes decisions (approval or denial) not justifiable in the contract or medical criteria (Good ol’ boy decision making)
261.
262. Member services performs satisfaction and accountability studies and generates reports - knows the skeletons