A doctor who left primary care in Milwaukee to become a chief medical officer at a health plan explains why physicians should help make coverage decisions. He argues that doctors bring scientific rigor to policy and can improve how care actually gets delivered.
I did a busy primary care practice in suburban Milwaukee for 25 years, but my full time job now is I'm the chief medical officer for a local health plan. There's probably some benefit to having docs at the table where decisions are made that can influence how practices and care is delivered. It's probably important to have our voice in the room. You know, it's probably better to be involved to see if you can make things better for both doctors and patients. If you can influence how things are, policies are laid out. Once you get exposed to seeing how the decisions are made, then you see that, okay, there's actually some science behind why people will say no. Whether something is considered to be more experimental in the clinical trial phase versus no. This is standardly accepted practice that everyone's doing now. We should be paying for this as standard of care. And once I saw that there was some degree of science that was behind it, and it wasn't just strictly people doing denials, then I was more open to the idea of being more integrated with the health plan.
Physician Takes a Youth Sports Team to the State Championship - MtoM Podcast #236
