Program Offers Physicians-in-Training an Inside Glimpse of Managed Care
From 1998 to 2000, Harvard Pilgrim Health Care, a managed care organization based in Brookline, Mass., enabled medical residents at the University of Medicine & Dentistry of New Jersey (UMDNJ)-Robert Wood Johnson Medical School campuses in New Jersey to receive training in delivering health care in a managed care environment.
Training was delivered through two managed care health systems in New Jersey: the Pinnacle Medical Group and the Cooper Health System. The training program was part of a larger effort by the Partnerships for Quality Education, Boston, a national initiative conducted under the auspices of Harvard Pilgrim and supported by The Pew Charitable Trusts.
The Partnerships for Quality Education funds partnerships between academic medicine and managed care organizations to create educational models for training residents for quality practice within managed care organizations. After a national call for proposals, Pew funded 25 projects and sought support for 45 more from other partners, including The Commonwealth Fund, the California HealthCare Foundation, and the W.K. Kellogg Foundation.
The Robert Wood Johnson Foundation (RWJF) was asked to support the planning and implementation of managed care training programs at the UMDNJ-Robert Wood Johnson Medical School campus in New Brunswick and at Camden.
Through a partnership between Partnerships for Quality Education partnership and the Cooper Health System, UMDNJ-Camden medical school residents did the following:
- Participated in a one-week training at Mercy Health Plan, a managed care organization within the Cooper Health System, working closely with the senior medical director to better understand the process of managed care utilization review and case management.
- Participated in a one-week rotation at Aetna US Healthcare, organized by the Cooper Health System, during which residents worked with the regional quality director to look at quality improvement, patient care, and office management systems.
- Helped to provide services at Charity Care, a managed care entity within the Cooper Health System that serves indigent patients.
At the UMDNJ-New Brunswick campus, program goals could not be fully realized due to the financial problems of the managed care partner organization, the Pinnacle Medical Group, which resulted in Pinnacle downsizing a number of sites, including the New Brunswick Health Center, where residents were to practice.
Nonetheless, residents were able to rotate through a Newark, N.J. Medicaid health maintenance organization and participate in developing a continuous quality improvement program in diabetes for internal medicine residents. Pinnacle also developed a curriculum for resident education in health-care administration.
Additional RWJF funds (Grant ID# 035720) were used during the grant period to support a one-day meeting of leaders from the fields of medicine, nursing, physician assistant programs, and managed care to recommend strategies and interventions for a second phase of the Partnerships for Quality Education.
Due to a change of mission, the Pew Charitable Trusts discontinued its support for Partnerships for Quality Education. In April 1999, RWJF authorized up to $9 million over a 54-month period for Phase II of Partnerships for Quality Education (Grant ID# 039496).
RWJF supported this project through a grant of $31,615.
GRANT DETAILS & CONTACT INFORMATION
Participation by New Jersey Medical Schools in Residency Training Programs in Managed Care
Harvard Pilgrim Health Care (Brookline, MA)
Dates: March 1998 to February 2000
Gordon T. Moore, M.D.
Report prepared by: Avery Hart
Reviewed by: Karyn Feiden
Reviewed by: Molly McKaughan
Program Officer: Susan B. Hassmiller