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Julie Miller was the former Managed Healthcare Executive Editor in Chief until May of 2014.
Physicians' first-hand experience has no substitute, and Dr. William Cromie has maintained CDPHP's vision of including physicians in the governance of this health plan. Often, the plan and the physicians are faced with tough choices and collective compromises.
That's why CDPHP (Capital District Physicians' Health Plan Inc. and its affiliated companies) draws its assembly of physicians into the board room to shape the organization's strategies. According to President and CEO William J. Cromie, MD, MBA, the physicians don't just chime in with random thoughts-they are tasked with making the hard decisions.
"We are very close to one of the big players, and that's our doctors," Dr. Cromie says. "It's an opportunity other health plans would love to have but probably can never have."
"Make no mistake-this is not a lovefest," Dr. Cromie says. "The health plans that were physician-directed and gave the farm away don't exist anymore. That's why we're such an anomaly. Somehow what we've been able to do is maintain discipline, and it's based on trust. [It is difficult to] tell doctors that you're not going to give them a 2% fee schedule rate increase-as much as you would like to-because it's not in the best interest of the health plan. They don't like it, but they choke it down. They understand it's right."
CDPHP might not be an anomaly for too much longer. According to Randy Killian, MBA, vice president of the Medical Director's Institute in Glen Allen, Va., and MHE editorial advisor, the trend nationwide shows more plans and physicians are trying to work together.
The emerging concept of patient-driven healthcare is based on putting the unique needs of individual patients above the health plan and physician's divergent interests, he says. The aim is to reduce costs and maximize the overall health of the community the health plans and physicians serve.
Preserving the practice