The following is a comprehensive catalogue of THCI programs and resources. Programs are customized for clients, and are taught by experts in the field. THCI can obtain continuing medical education credits for each program. Contact Rosalie Phillips, MPH, Executive Director of THCI for more information about the programs and resources.

• Physician Empowerment through Effective Organizational Structure
• Risk Sharing and Capitation: Follow the Dollar
• Office Practice and Managed Care for Senior Populations under Risk-Sharing Arrangements

• The Emerging Specialty of Physician Leadership
• Leadership and Change Management in the New Health Care Environment

• Teamwork and Survival in the New Medical Marketplace
• Re-Engineering Your Practice for Risk Sharing
• Linking Quality and Productivity to Physician Compensation
• Managed Care and Quality: Establishing the Critical Balance
• Clinical Productivity, Efficiency, and Effectiveness
• A Customer Service Orientation to Improving Practice Management
• Pharmacy Management
• Managing by Data
• Physician Satisfaction: What Hurts and What Heals?
• Accreditation '99: Making Results Count

• Patient Satisfaction — Measurement and Results
• Physician Communication: the Key to Compliance
• Improving the Relationship between Patient and Clinician

• Preparing Physicians-in-Training to Succeed in Managed Care

1. Introduction to patient-centered care in the managed care environment and ethical issues within the doctor patient relationship
2. Performing a patient-centered assessment
3. Arriving at a mutually agreeable plan
4. Involving the family in clinical decision making
5. Exploring common reasons for physician ineffectiveness and failure

• Essentials of Managed Care
• The Nuts and Bolts of Establishing and Operating a Call Center
• Case Management as a Marketing and Branding Strategy
• Problem Identification and Care Planning
• Ethics and Case Management
• The Impact of Managed Care on Nursing
• Chronic and Catastrophic Care Case Management
• Demand Management, Disease Management, and Case Management
• Palliative Care in a Managed Care Environment

Physician Empowerment through Effective Organizational Structure

As the health care system consolidates, physicians are forced from the private practice of medicine as solo physicians or small medical groups into a variety of organizational structures attempting to meet the demands of an evolving marketplace. Whether an IPA, PHO, PPM, staff, or group model, each possesses distinct advantages and specific weaknesses that must be understood in order to determine the optimal model for any one physician. After attending this session, participants will understand how each model is organized, what unique features each brings to the marketplace, and the impact of each model on its participating physicians.

Risk Sharing and Capitation: Follow the Dollar

This program provides an overview of capitated and risk-sharing contracts, and offers explanations of how physicians are affected by risk arrangements, incentive systems, and compensation formulas. The program reviews differences between aligned and perverse incentives and delineates policies and mechanisms for rewarding physicians equitably in a risk-sharing arrangement. Participants learn the differences between risk in commercial vs. senior plans, primary care vs. specialty capitation, and contract vs. point-based compensation.

Office Practice and Managed Care for Senior Populations Under Risk-Sharing Arrangements

This program is designed to respond to the growing number of risk and capitation contracts for Medicare beneficiaries. Practitioners who participate in risk-sharing arrangements need information and training about ways to deliver high quality, cost-effective care in a capitated environment, with a particular focus on the elderly patient. This includes approaches and techniques to enable practitioners to manage financial risk, change practice patterns, re-engineer the practice, and manage care across the full continuum of care sites. The focus is on patient satisfaction and quality assurance. Depending on the needs of the audience, the course can be delivered as a two-hour, four-hour, or six-hour course. The full course incorporates cases related to capitated budgets, utilization management, and ethical analysis for a capitated elderly population.

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The Emerging Specialty of Physician Leadership

In the past, physician leadership has focused on clinical roles for which their medical expertise fully prepared them as the captains of a team of health care subordinates. Now physicians are being asked to assume managerial roles often subordinate to non-clinical peers, which may require them to direct their previously autonomous colleagues on financial and operational issues for which they are far less well prepared. This two-hour session addresses the transitions required of all physicians as they take on new roles of both leadership and followership in an emerging managed care environment.

Leadership and Change Management in the New Health Care Environment

Success in managed care requires considerable change from traditional medical practice, particularly on the part of physicians. They need to recognize the context, accept the goals, and understand the processes involved. Steps in the process include assessing an organization's readiness to change, prioritizing initiatives, and overcoming barriers and resistance. Physicians are most likely to change their behaviors when other physicians are leading the effort. This program can be presented to physician practitioners to help them make the transitions, or to physician leaders to help them manage the people who need to change and the processes that need to occur.

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Teamwork and Survival in the New Medical Marketplace

Given the current climate of rapid change and constrained resources, clinical practices are not likely to survive without effective teamwork between and among clinicians, administrators and staff. Teamwork is one of the most important assets of any health care organization because it enables a group of individuals to achieve maximum results within available resources. Successful practices must become systems in which the entire organization functions as a high-performing unit, while maximizing productivity, patient satisfaction and the appropriate use of physician expertise. This in-depth workshop provides physician leaders and practice administrators with the knowledge and skills they need to create and maintain cohesive teams that meet day-to-day and long-term challenges of clinical practice.

Re-Engineering Your Practice for Risk Sharing

This program reviews practical success factors for the office-based practice in a risk-sharing marketplace. The course reviews marketplace forces requiring a shift from fee-for-service approaches to prepaid, population-oriented approaches. It also provides descriptions of practical methods for re-engineering the practice to improve access for patients; streamline utilization and provider productivity; monitor and improve quality; and obtain useful practice-oriented information. The program includes time for discussion of common barriers to change in the office practice setting — including physician resistance, unaligned incentives, accountability, and difficulties in performance evaluation — and methods for overcoming these barriers.

Linking Quality and Productivity to Physician Compensation

Physician accountability has become the guiding principle for a health care system focused on enhancing value through reduced cost and increased quality. Thus physician compensation systems are shifting toward pay-for-performance approaches that are unfamiliar to salaried physicians in group and staff model organizations. This half-day seminar uses an interactive computer program to demonstrate the impact of different variables of physician compensation and links them to established benchmarks for physician performance across different specialties.

Managed Care and Quality: Establishing the Critical Balance

Although it is presumed that the management of clinical resources that epitomizes managed care compromises the quality of patient care, in reality quite the opposite can be true. Ultimately, quality patient care results from operational systems and organizational integrity. This presentation reviews the impact of managed care structures, functions, and reimbursement mechanisms on the care and services provided to patients.

Clinical Productivity, Efficiency, and Effectiveness

This session demonstrates methods of collecting and reporting data regarding the care of individual patients as well as enrolled populations in order to manage successfully in risk-sharing practices. The program describes and illustrates the differences among measuring productivity, efficiency, and effectiveness. It emphasizes the importance of productivity measures that go beyond counting the number of patients per hour to approaches that include measures and data related to time, resources consumed, and goals achieved.

A Customer Service Orientation to Improving Practice Management

Medical practices must be responsive to the needs of multiple customer segments in order to thrive in the health care environment. In addition to those with patients, practices have relationships with several external customers: health plans and payers, referring physicians, hospitals, provider agencies, and others. Members of the practice also interact with one another as customers and suppliers. Delivering good service requires effective structures, systems and operations. This seminar will explore strategies for understanding a practice's customers and designing and implementing service improvements.

Pharmacy Management

Pharmacy costs are the fastest-rising component of the health care budget. The responsibility for managing the pharmacy benefit is shifting to physicians as part of their risk contracts. This program reviews current trends in prescription drug utilization and costs; discusses the challenges facing health plans, physicians, and other stakeholders; and recommends strategies and operational systems to effectively control pharmaceutical use and costs. These approaches include defining benefits and contract terms, collecting and disseminating data on prescription practice patterns, and communicating with patients to educate and manage expectations.

Managing by Data

This session discusses the data elements necessary for utilization management, quality management, and disease management, and reviews the elements of an effective data quality control process. The concepts of random variation and regression to the mean are discussed in the context of the health care industry. It emphasizes the use of basic process control tools that go beyond traditional spreadsheet reports. Hands-on examples allow the user to gain practical knowledge in "managing by data." This course is ideally taught in a two- or three-hour session with time for interaction and discussion.

Physician Satisfaction: What Hurts and What Heals?

Physicians as a group are experiencing declining morale and increasing frustration as they try to adjust to the changes in the environment and their own practices. This program reviews research findings on physician satisfaction overall and differences based on models of care, practice settings, and participation in managed care. It considers the relationships in satisfaction levels among physicians, office staff and patients. Based on the research and also upon discussion among participants, the program identifies indicators that contribute to higher and lower satisfaction — especially those factors within physicians' control that can improve satisfaction.

Accreditation '99: Making Results Count

NCQA's new integrated accreditation and HEDIS reporting system represents another "raising of the bar" for managed care organizations. This session discusses what's new in the accreditation and reporting process, and introduces the concept of "value purchasing" in health care. Issues of importance to clinicians and MCOs are discussed.

Patient Satisfaction — Measurement and Results

This program is organized in two parts: The first is a review of the current state of the art, including the difference between patient reports and patient satisfaction; and a summary of types of satisfaction surveys currently being conducted. The second part highlights results of recent surveys of the relationship between patient satisfaction and other factors, such as patient health status and demographics; physician characteristics; and health plan characteristics.

Physician Communication: The Key to Compliance

This course on physician communication has two parts. Each can be taught on its own, or they can be combined into a single, four-hour session. Part one reviews problems associated with patients' lack of compliance with treatment plans, barriers to patient compliance, and the increased malpractice risks associated with deficiencies in physician communication. It illustrates the difference between a physician-centered approach and a patient-centered approach to communication in a medical encounter. Part two teaches skills and techniques for applying the patient-centered approach to maximize patient satisfaction and compliance and provides behavior change strategies to increase patients' involvement in their medical care.

Improving the Relationship between Patient and Clinician

This intensive skill-building workshop is offered as either a half-day or full-day program. Practitioners learn from other skilled clinicians how to listen reflectively and to improve their skills in empathizing with patients. Participants develop tools for adjusting to a patient's knowledge, beliefs, and expectations as well as for creating and following through with specific patient-centered action plans. The three-function model of the medical interview is described and then practiced through role-playing. It includes: (1) data gathering — practicing skills to obtain the patient's story efficiently, (2) relationship building — practicing skills to listen for feelings and respond actively — and (3) patient education — practicing skills for telling a meaningful diagnosis as well as for negotiating and implementing a plan. As a result of this learning and skill acquisition, participants can expect to have more comfortable and effective relationships with patients and to achieve better patient compliance with treatments. Note: a ratio of one faculty member for every 10-12 learners is necessary for this workshop.

Preparing Physicians-in-Training to Succeed in Managed Care

Residency program directors are under increasing pressure to prepare young physicians for practice in a managed care environment. This faculty development course provides program directors and faculty with knowledge and tools they can use to teach their residents in four critical areas:

• Understanding the Basics of Managed Care — includes a self-paced, interactive CD-ROM
• Practicing Patient-Centered Care in the Managed Care Environment
• Model Managed Care Curriculum for a Rotation in a Community Practice and MCO
• Evaluating, Adapting, and Using Clinical Practice Guidelines

Each unit contains a comprehensive curriculum guide and materials designed to teach primary care residents to deliver high quality, cost-effective care within a managed care system.

1. Introduction to patient-centered care in the managed care environment and ethical issues within the doctor patient relationship. This three-hour course begins with a one-hour introduction to a patient-centered model contrasting it with the biomedical model. The course describes essential issues inherent in the patient-centered model, such as: 1) patient-physician relationship issues; 2) communication skills; 3) managed care issues; and 4) health effects of the patient-centered model. These include improvement in disease specific health outcomes, patient satisfaction, retention of patient-provider practice and patient-provider relationships, as well as reduction in discretionary utilization, and malpractice claims. Maintaining trust in the patient-physician relationship in the managed care environment is emphasized.

   A two-hour session then follows on the ethical issues related to the patient-physician relationship within the managed care environment. An ethical framework, including values of beneficence, autonomy, and justice is described as the basis for ethical solutions. Cases on gatekeeping, financial incentives, distribution and use of medical resources, informed consent versus individual issues, and end-of-life decision making are used for case discussion with the entire population group.

2. Performing a patient-centered assessment. This two- or three-hour workshop develops skills to perform a patient-centered assessment, including eliciting the patient illness prospective, responding to patient feelings, and reaching agreement on the problem. A practice session using patient-provider scenarios with an observer providing feedback concludes the session.

3. Arriving at a mutually agreeable plan. This three-hour course develops key skills in arriving at a mutually agreeable plan, including understanding principles of negotiation, the change process, goal setting, option generation, and option selection. Patient-provider scenarios are used to practice key skills, including the use of an observer to give feedback.

4. Involving the family in clinical decision making. This three-hour workshop helps providers understand how systems to which the patient belongs— such as the family system— can affect the patient's health and affect clinical decision making, how families can facilitate change, how to mobilize family and community resources, and how to recognize transference during a family interview. Practitioners also develop skills in assessing families— particularly the family's explanatory model of illness— during practice sessions using scenarios.

5. Exploring common reasons for physician ineffectiveness and failure. This three-hour workshop helps participants understand common reasons for therapeutic ineffectiveness and failure and describes how to constructively respond to difficult patient-physician interactions, recognize countertransference issues, and how to successfully terminate a patient-physician relationship. Practitioners engage in a family-of-origin exercise in which they develop self-awareness skills. Through self awareness, participants learn to develop better patient-centered care skills, strengthen the patient-provider relationship, and benefit from analyzing failures rather than denying them.

Essentials of Case Management

This is an introductory program for case managers or nurses who desire to become case managers. The content is general in nature and describes all of the roles of a case manager, including those in a health plan, hospital, medical group, and IPA. Roles, responsibilities and job duties are described and are compared and contrasted in a complex patient case study.

The Nuts and Bolts of Establishing and Operating a Call Center

A call center is a complex organizational system, whether its purpose is utilization management, case management, and demand management or physician referral. This practical two-hour session describes the details of costs, service standards, training, staffing, and productivity of a call center and provides practical hints for developing a dedicated call center.

Case Management as a Marketing and Branding Strategy

Case managers are the new channelers of managed care patients to tertiary care providers and Centers of Excellence. This program reports on a survey sent to 2000 case managers which asks them what would convince them to change referral patterns and to utilize one facility over another. The results of this survey demonstrate that while cost is a factor, it is neither the main factor nor the only one considered. This session describes what managed care organizations expect from their referral centers and how case management can be used as a branding strategy in marketing efforts.

Problem Identification and Care Planning

This program for case managers teaches how to correctly identify patient problems and needs, and how to create an appropriate care plan. The two-hour session includes didactic material and a case study for which participants complete a simulated care plan.

Ethics and Case Management

With the increasing complexity of the health care industry, case managers frequently confront ethical and moral dilemmas. This 60-90 minute session explores the guidelines available to case managers for ethical practice, traditional ethical principles and their application in practice, ethical conflicts in health care, decision making, and coping with ethical issues.

The Impact of Managed Care on Nursing

This two-hour program is designed to educate staff nurses from all settings on the changes occurring in the health care industry, with an emphasis on the impact of managed care. Nurses gain an understanding of the business of managed care operations, clinical systems, quality of care, and the health care continuum within a capitated system. Patient case studies are used to demonstrate the positive aspects of a managed care system.

Chronic and Catastrophic Care Case Management

Case management is changing from being reactive to focusing on proactive management of patient care. This program compares and contrasts the approaches of chronic care management and catastrophic (or large) case management, including differences in targeting, identifying, and intervening. Case examples and exercises are included in this 30-45 minute presentation. It is recommended that this session be delivered in combination with the presentation on Demand and Disease Management described below.

Demand Management, Disease Management, and Case Management

This presentation defines the concepts of demand management and disease management and discusses how these interventions and programs are best applied as part of case management. The 30-minute session includes case examples and exercises to help learners determine which strategy to use. It is recommended that this session be delivered in combination with the presentation on Chronic and Catastrophic Care Case Management described above.

Palliative Care in a Managed Care Environment

This one- to two-day program, designed for case managers, addresses how to improve care for seriously ill and dying patients. It considers in a comprehensive manner all of the components that are at play in the lives of terminally ill patients, including pain control, symptom management, family and legal issues, communication concerns, and psychosocial and spiritual care.