A conversation with Thom Rosenberg
05/19/2013 6:51 AM
08/08/2014 10:17 AM
For Thom Rosenberg, the end of one career brings about the start of another.
“People that know me know that I’m a little hyperactive. I want to be kept busy and be able to make a difference,” said Rosenberg, who practiced medicine in Wichita for 39 years before becoming medical director for Preferred Health Systems in March.
The Pittsburgh, Penn., native first came to Wichita during his time in the Air Force at McConnell, where he was chief pediatrician.
After completing an allergy fellowship, he was offered a partnership in Wichita, where he practiced from 1974 to this year.
Rosenberg has served as the mayor of Eastborough, helped form the Child Protection Team at Wesley Medical Center, was an associate professor of pediatrics for KU School of Medicine-Wichita, and was “Dr. On Call” on KAKZ radio and later KAKE-TV in the 1980s and 1990s.
He is also chairman of the Wichita Airport Advisory Board and on the board of directors for Wichita Area Sister Cities with his wife, Adrienne. Last year, they visited Kaifeng, China, as part of the program.
What does the medical director for an insurance company do?
We have nurse teams that review patients in the hospital and make sure they’re getting the appropriate levels of care. We are very concerned with quality of care issues.
It’s basically opened my eyes as to what we do as a managed care facility to make sure we’re offering the best possible care to patients who have our insurance program.
I also help to supervise special investigation units for fraud and abuse. The thing we try to do is keep the cost of health care down, and if we can keep the cost of health care down, the cost of insurance is less. So it benefits the patients. ...
We try to make sure the level of care the insurance company is being charged for is appropriate.
What’s the transition been like from doctor to medical director?
I just feel like I took this job to make a difference, and just to let people know that certain insurance industries are not a bad place. Some people say medical insurance is bad with the new environment and new Affordable Care Act. We’re basically here to offer a unique service to help people afford medical care. Efficiency is so important. Quality of care, helping patients manage their illnesses.
One of the unique things about Coventry and Preferred Health is the way we have case managers help patients understand their illnesses, why it’s important to take meds and keep office visits with physicians. People say, “Insurance companies do that?”
You better believe it. …
When you have good patient care, the cost goes down, and everybody wins. I’m not an insurance guy. I’m just a doctor.
What are the biggest challenges of your new position?
Keeping the cost of health care under control. A simple X-ray is no longer $25. You have MRIs, CTs. You’re looking at thousands of dollars. Equipment costs are so expensive.
So what are some ways that, as a system, we’re going to be able to achieve lower costs?
It’s up to the patient and if a patient manages themselves in the proper way.
One of the biggest things is, as our population ages, what can we do to decrease the instance of heart disease? Heart failure is going to be a tremendous problem in the next 15 to 20 years. Smoking and controlling weight. So we talk about health management and keeping as healthy as possible to decrease the bad outcomes. Education.
How does your background as a physician help in this new role?
The fact that I’ve been here so long, I feel like I’m in a unique position. The physicians know who I am, and I think I am better able to address physicians who have questions about insurance. There are times I have to do peer-to-peer, why doctors want this particular procedure as we look at certain criteria that has to be met. … Just because you have a sore throat doesn’t mean you need to have your tonsils removed.
Physicians have egos, and we all think we know what’s best for a patient, and it’s trying to manage that. The bottom line is you want to do what’s best for the patient. The key is not what’s best for the insurance company, we’re looking out for the patient. If we can manage care and take good care of the patient, the outcome is better.