For some physicians, the thrill of medicine comes from healing patients one at a time.
But for Linda Lyons, M.D., it comes from charting the course of healthcare for the 3.9 million enrollees and 55,000 doctors in the expansive network of PacifiCare Health Systems.
"The gratification comes from a job well done and seeing results on a much larger scale," says Lyons, new senior vice president of health services and chief medical officer for the giant managed-care company based in Cypress, Calif.
The network has more than doubled in size since Lyons joined PacifiCare in June. PacifiCare recently acquired FHP International Corp., a chief competitor in California. As the country's largest Medicare HMO, PacifiCare this year expects combined revenues of more than $10 billion.
But buying FHP and stretching beyond California to 13 other states and Guam presents Lyons with a formidable challenge: retaining PacifiCare's good provider relations.
This mission is reflected in one of the company's vision statements: Every provider, given the opportunity, should choose to participate with PacifiCare. That belief is at the core of how PacifiCare, and Lyons, do business.
"That's my intention," says Lyons, 47, a Harvard Medical School graduate. "Don't tell me anything different.
"Empowered and accountable" doctors are the key to fostering PacifiCare's good provider relations, she says. "Our system allows physicians to practice medicine and make clinical decisions, and that is a very satisfying place to be."
The FHP merger could take at least two years, and the integration of two companies means "you have a corporate culture challenge," says Peter Boland, an analyst and president of Boland Healthcare in Berkeley, Calif. It's a challenge, he says, because the companies practiced "profoundly" different business philosophies.
PacifiCare tends to be more provider-friendly. For example, it partners with medical groups on a multiyear basis in exchange for holding down reimbursement rates, Boland says. FHP liked to negotiate contracts yearly to get as low a rate as it could, had a reputation for poor customer service and was criticized for its relationship with doctors.
Already regarded as a "very smart, well-managed company," PacifiCare will have to build business trust to make the integration successful.
"(Trust) has been in pretty short supply in the HMO industry," he says.
Before joining PacifiCare, Lyons worked for 10 years at Scripps Clinic Medical Group in San Diego, where her most recent title was senior vice president in charge of managed-care operations.
Dan Dworsky, M.D., a former colleague at Scripps, understands the lure of a company like PacifiCare to someone as ambitious as Lyons.
"They've got such deep pockets," says Dworsky, who replaced Lyons as head of Scripps' managed-care operations. "They can do things we could never do at a medical group level."
Dworsky is anxious to see what impact Lyons' strong provider background will have in her new job, and he's confident of the end result: "There's no doubt Linda will do a good job wherever she goes."
During her time at Scripps, Lyons worked with PacifiCare as a contract provider, gaining insight that proved to be extremely useful in her new job.
"If you've never been there, it's hard for you to understand the problems doctors are facing at the delivery level," says James O. Hillman, who resigned March 31 as chief operating officer of the American Medical Group Association.
Lyons previously chaired an AMGA predecessor organization known as the Unified Medical Group Association.
"She's one of the brightest people I've ever met in my life, really," Hillman says. "Along with that brilliance, she is practical, which is not often a combination you see."
Sam Ho, M.D., PacifiCare's vice president of western health services, echoes that assessment. He has known Lyons for about six years.
"She's got an extremely detailed and sophisticated understanding of the operational elements within a provider delivery system," Ho says. "She's got the technical skills, the insights and perspective as well as the credibility to make PacifiCare even more effective in its already respected relationship with providers."
Lyons' interest in the administrative side of medicine dates to her medical school days at Harvard in the late 1970s.
"It was a desire to make things better," she says, a desire that still drives her today.
At PacifiCare, one of her major challenges will be working to control health plan pharmacy costs. Other responsibilities are improving patients' health and developing contract strategies, such as defining responsibilities and how to best work with providers.
She counts the FHP acquisition as her biggest on-the-job challenge so far,< citing the volume of documents requiring attention and the sheer size of the transaction.
One of Lyons' priorities is to encourage networkwide use of capitation, rather than fee-for- service, as a payment structure.
To Lyons, capitation makes for good business and good medicine.
"That kind of prepayment fosters a thinking about preventing illness," she says.
Other initiatives she's looking forward to include an increased focus on maternal and child care, diabetes, cardiovascular disease and depression.
Born in Ohio, Lyons has spent most of her medical career in California. She earned her bachelor's degree in physiology from the University of California at Berkeley.
After graduating in 1980 from Harvard Medical School, she went on to an internship and residency at UCLA Medical Center in Los Angeles.
Lyons first worked for the Permanente Medical Group, now Kaiser, and then another medical group before joining Scripps in 1986 as an internist.
During her years at Scripps, Lyons served as medical director and then advanced to executive positions overseeing resource management and, ultimately, managed-care operations.
Married with two children, Lyons commutes 90 minutes each way from her home in San Diego County to PacifiCare's headquarters in Orange County. It's in her car and on the phone that she begins to whittle away at some of the day's tasks.
"It's my free time," she says.
When Lyons joined PacifiCare, Jeffrey Folick, the company's chief operating officer, had a broad challenge in mind: "Making sure our strategies are integrated."
Folick says that includes getting all its health plans accredited by the National Committee for Quality Assurance and ensuring that decisions about what's covered and what's not are made uniformly throughout the network and not state by state.
Controlling pharmacy costs is a particularly important charge for Lyons because they're rising faster "than any other area in healthcare," Folick says.
Folick remembers that not long after Lyons started, she and other company executives undertook the massive job of due diligence on the FHP merger. They were immersed in paperwork and spent hours poring over documents.
"Linda was effective in breaking the ice and saying something to keep people's spirits up," Folick says. She brings intangible qualities to her new job, "vitality and . . . a sense of humor."
Personal professional goals she set for herself include providing leadership and strategic direction for health services, focusing resources, and identifying issues, such as cost and quality, and then developing plans to address them.
Reflecting on what she has done, Lyons is pleased with her progress.
"I'm where I wanted to be," she says.
And she's not the only one who's pleased. "She has really added a lot to the company," Folick says.