Dear Abby gives practical advice to those with relationship and lifestyle problems, but she's not in the business of providing help for physician executives.
Not to worry. One group of physician-led health plans in the Midwest has found a better answer: They give advice and counsel to each other.
Executives of several health plans affiliated with multispecialty practices have been meeting twice a year for nearly nine years with a group of their peers in noncompeting markets. They use the forum as an opportunity to share experiences and data about what works and what doesn't as their organizations struggle to adapt to the rapidly changing healthcare climate.
"We're (the health plans) all very similar in size -- very similar in our relationships to clinics," says Lawrence E. Cremer, who recently retired as chief executive officer of Medical Associates Health Plans of Dubuque, Iowa.
"We really don't have much in common with a health plan that has a million members -- being physician-owned changes the equation considerably."
Along with Medical Associates, the group includes PersonalCare of Illinois, Champaign, Ill.; Arnett Clinic, Lafayette, Ind.; Lexington (Ky.) Clinic; and Welborn Clinic, Evansville, Ind. One Chicago-area plan dropped out of the group after being acquired by Blue Cross and Blue Shield of Illinois.
The next meeting, planned for early September in Kohler, Wis., will bring together CEOs, medical managers and finance executives. It should prove especially valuable for Larry LeGrand, an OB/GYN who was appointed medical director of the Medical Associates plan last November and is looking for help in shaping his new role.
"The idea is to share common ideas and common goals," LeGrand says.
The health plan is a wholly-owned subsidiary of Medical Associates Clinic, a multi-speciality clinic of 100 physicians, 71 of whom are shareholders.
The open panel plan also contracts with a number of physicians in communities within a 60-mile radius of Dubuque. Its market includes parts of Iowa, Illinois and Wisconsin.
Cynthia Thumser was recently promoted from director of managed care to replace Cremer as the new executive director.
The health plan, which has been in operation since 1982, has 41,000 enrollees -- 23,000 in a traditional HMO. Its Medicare supplement includes 7,000 enrollees, and it also administers plans for companies that want to self-insure.
The group had 1997 revenues of $60 million and net income of $400,000.
A dominant clinic in the region, its major competitors include John Deere's Heritage Health Plan. Executives credit the plan's success to early recognition that managed care is here to stay.
"We believe if we provide quality medicine and a competitively-priced product, the patient will be served well and we will have fulfilled our role as a delivery system," Cremer says.
Adds LeGrand: "The advantage of this plan over a larger plan is we don't have anyone trying to micromanage us. Physicians know ultimately they are at risk for the healthcare dollars, and they also know it's important to provide quality care and have happy patients."