Dr. Kate McIntosh was a member of the class of 2019 and is the Senior Medical Director and the Director of Quality for Blue Cross and Blue Shield of Vermont (BCBSVT). She transitioned from private practice as a pediatrician and Chief of Pediatrics at her local hospital to this role during the last semester of the Executive MBA for Physicians program. Below, Dr. McIntosh tells us more about her new role, moving into the insurance industry, and how her MBA degree has helped her in this journey.
Please tell us about your new roll. What are you responsible for?
I am the Senior Medical Director and the Director of Quality for BCBSVT. BCBSVT is one of the smallest of the independent health plans of the Blue Cross and Blue Shield Association. Working for a health plan as a physician can take many forms, and one of the advantages of working for a small health plan is that I get to do a large variety of things which might be done by separate people at a larger plan.
I am one of only two physicians employed by the plan. Dr. Joshua Plavin, the CMO, is also an alumnus from the Brandeis Executive MBA program; he graduated in 2017. The two of us are the voice of the physician within the organization. Whereas Dr. Plavin’s role is more external and strategic, mine is more internal and operational.
As Senior Medical Director, I am responsible for medical policy, coding, and supporting all of the internal departments of BCBSVT by lending a physician perspective. As part of this, I support the utilization management nurses and the appeals team and coordinate a team of contracted physicians who do medical reviews. The speed at which medicine is changing seems to be ever-accelerating, and it’s an ongoing challenge to keep up with the latest changes in technology and pharmacology.
As part of my work as the Director of Quality, I oversee our HEDIS measures, our NCQA reporting, our internal quality initiatives, and the metrics and reporting for the quality and value-based projects with our local ACO, regional hospital networks, and other provider groups. I also work closely with the quality nurse and provider contracting to review patient complaints and to provide feedback to hospitals and providers throughout Vermont. I also work with the Fraud, Waste, and Abuse department to look for red flags or concerning behaviors. Fraud is a growing area of concern in health care, estimated to cost the United States up to $68 billion annually.
What did you do before this new role?
Before I started at BCBSVT, I ran my own practice for 16 years and was the medical director for the Vermont Health Information Exchange. I was also Chief of Pediatrics at my hospital and sat on its board of directors. Coming to a health plan from owning and running a practice has allowed me to bring a useful and less common perspective about the business of medicine to the organization and to the conversation about health care in Vermont as a whole.
Why did you want to transition into the insurance industry?
I never thought that I would work for a health plan. After 22 years of practice, I wanted to do something different. Running a practice had shown me that I really liked administrative work, and I wanted to do something that let me use my administrative skills. I would not have come to BCBSVT if it hadn’t been for Dr. Plavin, who was instrumental in encouraging me to enter the Brandeis program and also in bringing me to BCBSVT. I started at BCBSVT as a contractor doing medical reviews, but quickly found that the type of systems thinking required was a good fit for me. When the Senior Medical Director position opened, I knew that I wanted to apply for it. The Director of Quality was added later as part of a divisional reorganization but has made tremendous sense for the organization as a whole and has made my position even more interesting and rewarding.
Did pursuing the EMBA for Physicians impact your ability to get this new role? If so, how?
I think that it is fair to say that I would never have gotten this position without the EMBA program at Brandeis. Dr. Chilingerian’s teaching especially was instrumental in allowing me to enter the company as a contractor and quickly to be able to understand the needs of the organization and how best to meet them. This was a significant culture shift from where I had been before and a completely different type of organization. I think that the EMBA program helped me make the rapid pivot that was necessary to get this new role.
How has the EMBA for Physicians program helped you in your new role and which skills and tools from the EMBA program have you been using the most?
Every class that I took in the EMBA program has helped me in my new role. This new position sits at the intersection of business, health care, health reform, and politics. In addition, I use the tools we learned for strategy, finance, quality, ethics, and operations management on a daily basis. The courses have been critical to navigating the complex world of value, where quality and cost intersect. Dr. Plavin and I are both interested in encouraging providers to push forward innovative value-based projects and health reform initiatives, and we have to sell these both internally and externally, not only to health care leaders, but also to multiple stakeholders, including politicians, actuaries, and executives. In addition, I am working to optimize many of our internal processes which often involves all the diverse change management and communication tools that we learned or touched on in school, especially when working with teams from multiple departments and with multiple skill sets and priorities. The white board in my office is often a mess of flow charts and operational diagrams. Dr. Morrison would be amused!