Newsroom | Collaborative Care

Doctors cover a lot of ground during their four years in medical school and then more years of training as residents.  

But something big is missing from most curriculums: the basics of health insurance. Even though doctors interact with health insurers every day as they practice medicine, not many doctors have a first-hand knowledge of how health plans function.

“One day, we had a few hours’ lecture on health insurance, and that was it,” says Dr. Allison Rzepczynski, a medical resident at Rush University Medical Center in Chicago. “So maybe three hours of four years of medical school.”  

Craving more perspective, Rzepczynski chose to complete a rotation covering managed care at Blue Cross and Blue Shield of Illinois to learn what health care looks like from an insurer’s perspective.

“I wanted to have a core understanding of the insurance aspect of health care,” Rzepczynski says. “And I wanted to learn about other careers that a doctor could do that are outside of working in a hospital.”

The program

BCBSIL’s four-week Managed Care Residency Program shows residents like Rzepczynski firsthand how a health insurer operates.

“As we continue to develop new and innovative partnerships with physicians, this program is a key component of building that partnership,” says Thomas Maryon, vice president of clinical operations at the five Blue Cross and Blue Shield Plans in Illinois, Montana, New Mexico, Oklahoma and Texas.

The first week is a crash course in health insurance and health care management. Residents learn from BCBSIL’s experts about accreditation, medical policy, managing provider networks and how BCBSIL helps members navigate the complex health care system to improve access and help members achieve their health goals.   

They spend the remaining three weeks working with BCBSIL’s medical directors — the company’s employed doctors who help members get quality and cost-effective care. 

The residents see how doctors at BCBSIL review claims to determine if the ordered services are medically necessary, safe and effective according to clinical guidelines and evidence. They also learn how to spot signs that a claim might be fraudulent. 

“As residents, they’re never exposed to this at all,” says Jordan Rutledge, project manager of the curriculum in Chicago. Rutledge shepherded the first three participants, including Rzepczynski, through the program.

“What makes this unique is this is an experiential curriculum,” says Dr. Richard Abrams, internal medicine physician and associate dean for learning education at Rush. “It’s not sitting down and reading about things. They are really embedded within the organization to get an understanding of these areas.”

BCBSIL has hosted residents from Rush at its Chicago headquarters and is currently recruiting residents for rotations for 2019-2020 rotations.

“To the best of my knowledge, there has been no kind of educational partnership between an insurer and an academic medical center around education,” Abrams says. “I’ve never, ever, ever seen anything like this.”

New sense of partnership 

Graduates of the Managed Care Residency program say the rotation changed how they approach some day-to-day tasks working with patients in the hospital, especially documentation and coding for claims. 

But it also changed how they view health insurance in general.  

“From our point of view, the only time we’re encountering insurance companies is when a claim isn’t getting approved,” says Dr. Stephen Sawyer, another of the first Rush residents to attend the program. “But hospitals and insurance companies aren’t enemies; we’re fighting for the same end goal: To improve the health of patients.”