Getting Generalists, Specialists and Insurers in Sync

    • August 1, 2000

The Society of General Internal Medicine (SGIM) developed a supplement to the Journal of General Internal Medicine on the role of the physician in managed care, which was published in January 1999.

The supplement was based on papers from an SGIM managed care symposium, "The Evolving Role of Managed Care: Defining Educational Priorities," held on May 1, 1997, in Washington, D.C.

Recent changes in the nation's health care system have created the need to examine and develop teaching models on the role of the physician in managed care. However, no knowledge base existed to guide these processes. For example, medical texts rarely addressed such issues as when to refer patients to specialists.

The goals of the symposium were to:

  1. encourage physician generalists and specialists to develop principles to inform the relationship between generalist and specialist, and to develop strategies for teaching about these principles.
  2. bring together primary care physicians and experts in the doctor-patient relationship to examine emerging issues in this relationship unique to managed care settings, and to discuss how to teach about them.
  3. assess issues of the physician and the organization in a managed care setting, and to develop strategies to teach physicians about their new roles in these relationships.

The principles and strategies developed address issues seen as crucial to enhancing managed care in the future, affecting:

  • availability of appropriate specialty consultation
  • continuity of primary care
  • disclosure of financial incentives to patients and physician colleagues
  • the contractual arrangements of providers and organizations.

Key Results

  • The supplement was published in the Journal of General Internal Medicine in January 1999.

  • SGIM distributed 10,000 copies of the supplement to:

    • its membership
    • the memberships of STFM, AAPP, and ASP
    • selected leaders of health plans
    • opinion leaders

Key Findings

The 11 articles in the supplement, entitled Physicians and Managed Care: Challenges in the New Environment, address the following issues:

  • An overview of what is and is not known about the impact of changing reimbursement practices, with an emphasis on the importance of assessing financial incentives within a context that includes all strategies for influencing physician behavior, including administrative interventions and quality-measurement efforts.

  • Guiding principles (derived from long-established codes of ethics) for interactions between generalists and specialists that articulate responsibilities for the referring physician, the consulting physician, and health plans.

  • How organizations can enhance physicians' efforts and help move primary care practice from a series of individual interactions to an expanded focus on population health.

  • The essential aspects of physician-patient relationships, along with a description of incentives, opportunities, and strategies for sustaining trusting relationships in a changing health care environment.

  • Current endeavors and struggles among SGIM members to address educational and clinical challenges while also attempting to understand and influence the multiple systems in which they work.