What qualities do you need to succeed in managed care careers?

You need a desire to make the health care system better for the provider and the member. This focus will help guide you to better results and outcomes.

Healthcare careers are very rewarding but come with incredible responsibility. Patients depend on their insurance companies to help them understand very difficult concepts which are often perceived a certain way in the community. Communication skills are critical in managed care. You must be able to explain complicated concepts in a way that anyone can understand them and have the patience to actively listen to concerns.

Know. Your. Audience. The "headline" of your message should vary depending on who you are communicating with. Telling a story or communicating a concept to the finance team will have a different headline than when you tell it to the clinical team. Understand your audience's needs, challenges, and context and tailor communication to them. Maintain clarity and transparency in your message, but address the headline and your communication is more likely to be heard, understood, and acknowledged.

Organize customized communication workshops and training sessions for your team. Tailor these programs to address specific challenges in dealing with providers, payers, patients, regulators, and colleagues.

Transparency. It's ok to not have an answer for a colleague, customer, or boss. Though I suggest following-it up with 'I'll investigate and get back to you'. Too many people use words and say nothing when they don't have an answer, or an answer they don't think a person wants to hear.

Instead of just evaluating historical data, practice analyzing future scenarios and their potential impact. Develop skills in predictive analytics to anticipate trends and proactively address challenges, ensuring that your managed care strategies remain forward-thinking and adaptable.

It is very important to focus on prevention of major health issues as well as preventing falls. It is much cheaper to address concerns in private practice rather than paying for hospitalizations. What could be a simple $80 visit to a provider can quickly turn into thousands of dollars if they are admitted to the hospital. It is true prevention is not waiting for something bad to happen, it's preventing them in the first place.

@MelissaCampbell said it perfectly: The classic quote from British mathematician George Box comes to mind, “All models are bad, some are useful”.

While at KPMG, we were faced with a challenge of decreasing patient wait times without compromising care quality. Drawing from my clinical insights as a physician, combined with the strategic acumen honed at Apollo Hospitals, I spearheaded an initiative to analyze patient flow data. Through careful examination of the data, I identified bottlenecks in patient scheduling and proposed a revamped appointment system. Implementing this not only reduced patient wait times by 20%, but also enhanced overall patient satisfaction. This real-life application of my analytical capabilities underscored their vital role in problem-solving and healthcare optimization.

In my experience, analyzing the data is only part of the skillset required in managed care. The ability to tell a meaningful story from the data, while understanding what to do with the analytics output is the difference between an academic exercise in numbers and having true impact. Too often incredibly smart people "crunch the numbers" and create a series of brilliantly calculated output that provides little insight or call to action. When honing your analytical skills, learn to ask, "So What?". If you can't answer that question, then you have most likely not told a compelling story or identified a clear need for action.

If there's one thing that's certain in the healthcare industry, it's that nothing is certain! Things are constantly changing and evolving within healthcare, so change management is a must. However, the key is finding a good balance between agility and focus. Change management isn't about pivoting in light of every new development in healthcare; it's about understanding when to stay on track and when to invest in new strategy.

Mastering change management is essential. Equip yourself with the skills to navigate and lead through organizational transitions. Develop strategies to communicate change effectively, manage resistance, and ensure a smooth adaptation process for your team and stakeholders.

Leadership is an important skill in managed care but should be accompanied with negociation skills. As, managed care requires a contract between payers (funders, patients, other paying third entity) or buyer of services, providers / sellers (healthcare providers / hospitals), and patients (beneficiaries of services), the quality and content of services to be delivered should be well negociated as well as payment (price, payment modalities). This has been seen in the implementation of the results based financing (performance based financing) in healthcare in some countries where the package of services and performance (quality indicators) were negociated based on specific needs and perspectives of all stakeholders / parts in the contract.

While hiring, we need to check for abstract and creative skill sets and create a scenario where you check on the persons native genre of emotions and social awareness. Leaders are made and not born is the mainstay. Should be true : thru experiences, depth perception, non- compromising on quality, peaking during crisis, fastest and best foot forward - makes one stand tall and people fall back on them no matter how senior. An Eye for picking out Leaders & Mentoring is something that’s not proactively done. We need to change our internal perceptions too and be King Makers.

Leadership is not about being a boss and being able to tell others what to do. Anyone could do that. Leadership is about being a coach, a compassionate support, someone who is not afraid to say the difficult things, a trusting empowering person, and a true servant who desires to see others around them be successful.

My experience with Apollo Hospitals group as Group CMO taught me that ethical skills are the most important in managed care. It includes: 1. Integrity, honesty, and professionalism 2. Awareness of ethical principles and regulations 3. Autonomy 4. Justice 5. Beneficence 6. Confidentiality Examples of ethical principles in healthcare: 1. Autonomy: A person has the right to have opinions, take actions, and make decisions 2. Justice: Patients will be treated fairly and equitably. 3. Beneficence: A physician has an obligation to provide selfless service in medical care. 4. Confidentiality: Essential and recurring subject in medical ethics. Ethical leaders offer patients a greater sense of security and trust in their hospital's capabilities

Lack of ethics in a person’s character / leadership can be smelt in over a mile. Honesty, Integrity, Ethics etc should be the values displayed everyday and nurtured too in Medical & Management Schools. There are scenarios where honesty & kindness with ethics is more often overlooked as weakness or a faced character. We need more people in the healthcare ecosystem who practice empathy & compassion - initially consciously till it gets sub conscious. With ethics - the ecosystem GROWS!

Great advice on ethics, also trust your gut instincts, you often know when things are unethical or just downright wrong. So often we choose to ignore our instincts and override them when we shouldn't.

I think being aware of the relevance and use of patient-centred approaches in healthcare is a better way to ensure the compliance with ethical principles in managed care. Ethical guidelines are available but everyone in the healthcare industry shoul develop skills and experience dealing with ethical issues specific to particular groups (children, elders, minorities, displaced people, etc.) as their needs are not standardized and vary largely from one group to another and over time! Integrity, honesty and professionalism might be constant, and should be applied all time. Some groups need particular attention, and specific ethical issues to deal with could arise when providing them care (i.e. some religious groups).

At Apollo Hospitals, I encountered a situation where a potential operational change promised significant cost savings but had a potential risk for patient care. Grounded in the ethical foundations instilled in me as a physician, coupled with the principles I learned during my MBA, I undertook a thorough assessment of the proposal. Weighing the benefits against potential patient risks, I advocated for an alternative that upheld patient safety and quality of care. This decision not only protected our patients but also reinforced the hospital's commitment to ethical practices. Such real-life scenarios accentuate the criticality of ethical considerations in decision-making processes.

Empathy — put yourself in someone else’s shoes. For 13 years I held medical director roles from front line utilization management to chief medical officer of a health plan. My mission to improve the quality and experience of care was guided by empathy. Once I had to decide whether to allow out of network (OON) care for a member with a rare cancer who did not have OON coverage. He was 40 with a family. I could have denied it quickly. Instead I spent hours collecting data and research to demonstrate that he could not receive the care in network that he could get at an OON specialty cancer hospital. I approved the case, the member went into remission, and he sent me a note of gratitude. Always remember we are all human. Have empathy.

Knowledge! Managed Care is a highly regulated industry. Get ahead by reading the regulations. So many people miss this (too boring? Or too busy) - you’ll get ahead of others quickly. If you work in Medicaid Managed care read the state contract with MCOs - they are online and available. Medicare Managed Care? - start with the CMS Medicare Manual; pick a chapter that matches your work interest. Then get really advanced by reading the HPMS memos as they get released (anyone can get access). Follow experts posting online (free blogs) and watch webinars (tons of free content out there).

In my experience I would say patience and integrity are sparse in this industry, yet are sorely needed. There is an underlying and unspoken belief that someone in the healthcare triad (payer, provider, patient) must lose for the others to win. This is absolutely false, but it permeates throughout the industry and hinders meaningful progress. As an executive, you must remain patient and steadfast as you attempt to operate within the principles of fairness and equity. One must always remain 100 percent committed to establishing structures, partnerships, and/or relationships where the needs of all those in the triad are met. Anything less will inevitably end in failure.

Under communication but also a separate skill is listening and making adjustments in how you explain things. This can be called “being easy to do business with” or “making complex things simple.” Managed care has a lot of standards, regulations, and terminology that makes it less than straight forward. What it takes to be able to explain how it works to a janitor, a physician, a CFO or a twenty year old at their first job is the depth of understanding needed in managed care. On the front line all of these can be the member spoken with. They can also be the client representative for the plan.

The ability to prioritize positive clinical outcomes is fundamental in managed care. Patient Focused Care: Managed care is all about optimizing healthcare delivery. Putting patients at the center ensures that their unique needs and wants are considered, leading to higher satisfaction and engagement. Data Driven Decision Making: A patient focused mindset involves using data to measure and improve clinical outcomes. Executives who understand this can make informed decisions to drive better patient care and financial performance.