Center for Health Care Improvement
 A collaborative venture between the 
Medical College of Georgia and BlueCross Blue Shield of Georgia

Mini-residency on teaching Managed Care Principles to medical residents

Background
The traditional model of health care is characterized by fee for service, multispecialty, and uncoordinated care. This model is increasingly subject to scrutiny by the medical profession, patients, hospitals, clinics, and third party payers. As an alternative, managed care promotes the coordination of health-care services by primary care physicians and capitated fee structures. Medical students and residents need to understand how the modern managed care system works, including the principles of and how to apply the population health care perspectives that are now being promoted by the managed care industry. The Medical College of Georgia mini-residency in Managed Care is designed to meet this need.

A model program
The Medical College of Georgia has developed, and implemented a managed care curriculum for senior residents which focuses on the application of managed care concepts. The model program on the application of managed care concepts is based within the Center for health care Improvement (CHI), a collaborative venture between Blue Cross Blue Shield of Georgia (BCBS-GA) and the Medical College of Georgia (MCG). The learning activities for this program takes place over four days at two sites. The first day is spent with speakers at MCG. The next three days are spent at the corporate headquarters of BCBS-GA. The curriculum fills a gap in current residency training programs and serves as a model for programs at other academic health centers. The curriculum gives residents a structured exposure to health care management, information systems and management, and health care evaluation in the care of patients within a managed care system.

Structure of the curriculum
The curriculum is based on individualized tutorials, actual corporate experiences, assigned readings and structured learning activities on policy and practice in managed care. Residents have intensive personal experience with day-to-day administrative and clinical issues with corporate officials from BCBS-GA as the primary tutors. The residents learn about:

• The origins of managed care 
• Physician profiling 
• Political issues facing HMOs 
• Physician credentialing 
• Medical management information systems 
• Clinical practice incentives 
• Quality profiling of physicians 
• Performance measurement Physician capitation 
• Accurate data collection, coding, and entry 
• Health services research 
• Terminology and methodology 
• Formulary 
• Disease management, utilization, and case management

The residents are evaluated by means of self-evaluation exercises and summative examinations. Program evaluation comprises questionnaires, survey forms, and formal interviews with the residents and BCBS-GA officials.

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Medical College of Georgia
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Department of Medicine | Medical College of Georgia
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January 17, 2006