MANILA, Philippines — Contrary to popular belief, medical doctors can become effective and efficient corporate managers.

Doctors share many of a business manager’s best qualities. “Both professions are full of highly committed people who work extremely hard—often to the point of damaging themselves and their families…The training of both is long, hard, and never ends,” writes Richard Smith, editor of “The British Journal of Medicine” in his article, “What doctors and managers can learn from each other: A Lot.”

“Both professions respond to financial incentives. Doctors like to fool themselves that they don’t, but there is overwhelming evidence that they do—just like everybody else,” Smith continues. “Managers and doctors are people of action. They are also used to taking risks. In both professions there are specialists: managers may specialize in finance, marketing, or human resources just as doctors may specialize in neurology or pediatrics. To be successful, both professions need competence in communication, but both have poor reputations as communicators. Both have excessive jargon. Interpersonal skills are also crucial in both professions, and the hardest part of management is the ‘touchy feely’ aspects. Doctors and managers have to break bad news and try to encourage people to change…”

Each likewise have unique characteristics that, when adapted by the other, result in a powerhouse product. Smith mentions medicine’s “stronger intellectual base” and the “lack of academic rigor” of the world of business. Medicine also works directly

Deogracias G. Reyes, MD, MMAS, MBA

President, Health Plans Philippines, Inc.

Cwith their “customers”, in this case, the patients. “Some time spent with customers is invaluable, and many senior managers find some way to build this into their working lives,” Smith acquiesces, “But this difference in orientation is important: doctors think first about their individual patients, managers think first about organizations. For any hospital or primary care trust to succeed it will need both kinds of thinking.”

In terms of strategic thinking and working with a team, however, it is doctors who will benefit more if they take their cue from managers, and not the other way around. It is with this sort of attitude and openness that Deogracias Reyes, MD, MMAS, MBA, takes the helm of Health Plan Philippines, Inc. as president.

Two years and a half into the position, Reyes and his new team of managers have already effected tangible changes in the organization—the most evident being the invigorated work force and a holistic and comprehensive approach to healthcare. “We believe that ownership of health is key to maintaining it, assuring that there is accountability,” says Reyes in a prior interview. “This is accomplished by building dynamic partnerships with our clients so that we can provide the kind of health services and products they need.”

With Health Plan Philippines commemorating its 25th year this year, and with the world of medicine embracing the “new breed of doctor” that Smith outlines in his article (and which may be, indeed, personified by Reyes), Reyes is aiming at improving sustainability of his organization, as well as empowering its clients with ethical and responsible healthcare.

Business Agenda caught up with the busy doctor—who holds a masters degree in Minimal Access Surgery from the University of Dundee, Scotland and an MBA from the Ateneo Graduate School of Business; attends to patients at The Medical City, St. Luke’s Medical Center and Jose R. Reyes Memorial Medical Center; is a core-faculty at the Ateneo School of Medicine and Public Health (teaching both medicine and management) as well as a clinical consultant and administrator at Sacred Heart Hospital of Malolos—to find out exactly how he plans to do it.

BA: Health Plan Philippines, Inc. has been around for the past 25 years, but remained low key. Was this a conscious decision by management—to stay beneath the radar?

Reyes: In the ’80s, the early years of the HMO industry, coverage was considered a prime service rather than a necessity. As such, we have remained exclusive in that sense allowing ourselves to service the few who purchased health maintenance plans. Personalized service, as many would call it.

After 25 years, we realized that the role HMOs play in Philippine healthcare has expanded tremendously. The profile of patients seen at hospitals has shifted from private patients towards HMO members. In terms of revenue, hospitals and clinics are financially sustained by the influx of HMO members.

This implies that today, HMOs play an undeniable role in healthcare financing. It has become a more prevalent entity in this respect, not anymore limited to a few. This is the direction the organization is now taking—to fulfill our new role as service providers to a broader populace.

The way we want to go about it is through very deliberate growth, matching organizational capacity with demand. So we’re doing it efficiently—the company grows along with the membership base so we don’t lose that personal touch. A lot of HMO members will declare that the industry has become very mechanical, industrialized, and that you cannot speak with anyone of position when you confer because you’re stuck with the call center or clerks.

We make sure that our clients have a direct line. In fact when an account has a substantial concern, I visit in my capacity as president. I consult with stakeholders and give assurance that we will work on it. Thereafter, my managers visit and implement action plans, but I make sure that I take the initiative and keep tabs on the matter.

BA: You’re a surgeon, come from a family of doctors, have background as a hospital administrator, and have an MBA—how does this all factor in running an HMO? How does this influence your perception of healthcare?

Reyes: At Health Plan Philippines, we practice a synthesis of these varied experiences. Based on appreciation of health care and management concepts, we use 1) communication to convey, 2) timely information to ensure, and 3) responsive and relevant service.

Healthcare is such a complex system involving a myriad of factors and stakeholders. We believe that the solution is to engage our members in a dynamic partnership through this approach. This is the service that we would like to provide, as an HMO—to bring it all together.

The unique combination of perspectives, if you can call it that; that specialty training, management concepts and exposure to the hospital industry is what we in the management team bring to the table.

I think the background from the different disciplines make it easier to change hats, understand how these factors come into play and ultimately helps in resolving conflicts in such a complex system.

BA: You are already well respected in your field as a surgeon—what is it about being president of Health Plan Philippines that appealed to you?

Reyes: Let me start by saying that for the past years, a revolution has been going on in medical education. In surgery for example, the mindset was: see one, do one, teach one. It was all about apprenticeship as advocated by American surgeon William Halsted.

All that has now changed to involve new models such as mentoring, coaching, self-assessment, ethics, leadership and other psychosocial components. These aspects of medical education complement technical competencies to promote a more complete approach to health.

Gone are the days of the “men who play God.” The limelight has thus shifted from the doctor to the patient.

The epitome of this revolution in medical education is a “new breed of doctor” that bridges technical competency, patient needs and the psychosocial milieu. Taking a step further, as I have shared with you (in the article by Richard Smith), management is a natural progression of this revolution. Not management in the business sense, but management as an added competency to make better doctors.

Nowadays, doctors will not say “we will cure disease,” but rather, “this is how we intend to manage your condition.”

The new breed of doctor has the entrepreneurial spirit; again, not only in the business sense, but likewise as social entrepreneurs. As such, they are aware that people can be mobilized and added to the armamentarium of medicines and surgical procedures to manage patients.

Take chronic and lifestyle conditions like hypertension and diabetes. Lifestyle modification is a cornerstone of successful management. And to prove a point, it is accepted that diet and exercise programs are always more successful with the support of the significant others—the true partners in health.

To sum up: What appealed to me was the simple fact that by leading an organization engaged in the provision of healthcare I get the opportunity to share the virtues of the new breed of doctor; to show what the doctor-manager can accomplish. Having an organization behind you to effect what you believe in is very difficult to pass up.

BA: Did you meet any challenges while taking on the new position? If so, what were they and how did you deal with them?

Reyes: I have been trying to relate change in our organization and society in general. In initiating a change effort, you ideally “create a sense of urgency, win over people to come in on the change effort, bestow ownership for change, and if they own the change, they become the effectors of sustainable change…”

Initiating change in a 25-year-old organization will present challenges. Corporate culture will have to be re-invented.

Informing the organization at all levels was prime among my considerations. Yes, this was expected to elicit reaction, and this was when the task of managing the change effort really began. Growth is always a very daunting task and not everyone is willing to undertake this. We found that people know what they want, and that they know when they have to move on. That was what we had to deal with, letting people determine their path—reinventing corporate culture and getting the right people on board to define it.

It’s a constant struggle to find people who are aligned. People went and people stayed. But I found that consistency in action and constant awareness of organizational goals automatically sets the stage for getting the right fit with people.

Transitioning into new leadership was another challenge. Organization-wide anxiety that came with it was so thick; you can literally feel it pushing back. I saw this as a challenge to the traditional view of a doctor used to working independently and not typically comfortable with leading as such. I had to dig deep. I drew from my early experience in primary health care (during medical internship) in the province, a real “doctor-to-the barrios” affair.

Community organizing in preparation for primary healthcare starts with assessment and diagnosis. Subsequent action is based on this. So I immersed myself in the day-to-day matters of the organization, maximizing interaction with staff. I learned what they did, how they did it and what they thought of what they do. After all that, I took a step back, processed and took it form there. That allayed some uncertainty. After all, I thought to myself; everything I knew about the staff I was about to lead, I learned first hand.

Now I can say the organization is the best it ever has been for quite some time now and we are not about to stop. Now we’re more progressive, more attuned to the needs of the today’s Filipino. We have a better pulse of the industry; we’re just not in our own little world, content with servicing our members. We’re reaching out to others in the industry to learn what they do, looking out and seeing the landscape, using the mindset of the new breed of doctor to bring about change.

BA: How did you prepare for the job?

Reyes: It was a matter of internal transcendence. Before I was doing this, I was progressively taking on administrative and operational responsibilities at Sacred Heart Hospital of Malolos. The management degree was geared toward this end.

Technically the degree was a Masters in Business Administration in Health (MBA-H). As such, the Philippine healthcare situation was part of the curriculum. This was my first big step.

All I had to call upon at this time was my medical training and knowledge on how medicine was practiced in the country. Having been trained abroad made me cognizant of points for improvement in terms of technology, process infrastructure and policy. As I got deeper into the program, I realized that there was a lot more to it than just the technical aspects of medicine and management. There were more details of medicine and management relevant to the society that healthcare was meant to serve.

I had to learn and open my eyes. I spoke with HMO members, patients in the countryside, and patients in the government-hospital setting to understand what their pains were and explore areas of further enlightenment.

In the same breath, I also endeavored to understand current health policy to gain appreciation of issues and how to regard them.

I was not trained to be this new breed of doctor; I was trained in the traditional classroom-lecture manner. I consciously sought to be a better doctor-manager and gain appreciation for things I used to take for granted. The MBA-H degree was a definite step towards this.

BA: What’s the most common misconception of healthcare?

Reyes: That healthcare is exclusive—it should not be.

Universal health is the ideal, but while this is yet to be realized, we believe that HMOs bridge the gap between healthcare costs and universal access to health services.

The model for the HMO industry is the sharing of the risk for disease among members. Paid-up premiums are pooled and medical costs are drawn from this. This pooling is sometimes enough to cover medical costs, and in cases that it is not, but it does provide considerable relief from out-of-pocket expense.

Health Plan Philippines has developed new and innovative health maintenance plans. These products consist of pre-paid health plans, as well as non-mainstream cost efficient health maintenance programs that seek to bridge the health finance gap for a greater number of people (secondary market).

BA: Are there trends in healthcare? How is Health Plan Philippines, Inc. keeping abreast of these trends?

Reyes: The industry is very competitive. The HMO market has achieved such sophistication that price leadership alone is not an acceptable strategy. Consumer power is very strong, and in a setting with numerous providers and low switching cost, we have adopted a strategy of improved service and products to remain competitive.

Additional coverage for death and disability has been integrated into almost all our health maintenance plans. Travel health coverage is also becoming popular. Medical treatment abroad and in some instances, even repatriation in selected cases, is offered.

Our coverage for the parallel (secondary) market segments has also been positioned. These are cost-efficient quality healthcare plans for non-regularized workers, and even pre-paid health products that have minimal documentary requirements.

Novel coverage is now being offered by industry. Coverage for new diagnostic and therapeutic modalities is becoming more liberal in our updated plans, and diagnoses generally regarded as exclusions in health maintenance agreements are now covered. Plans for HIV-AIDS are being conceived by industry and group cancer coverage has recently been launched by other HMOs.

Although we put a premium to personally attending to our members, we believe that technology can complement our efforts. We have found that this is something that a growing segment of our society responds well to. We utilize a range of communication technologies and an interactive website to bring us closer to our members and client organizations—our partners in Philippine healthcare

What differentiates us in implementing these strategies is our resolve to build dynamic partnerships though communication, education of stakeholders, efficient and relevant service. This resolve straddles our individual members, client organizations and health providers. This is the true extent of the partnership we seek—engage all stakeholders.

BA: How do you merge being a doctor and a manager?

Reyes: For one thing, doctors aren’t comfortable with uncertainty. Managers have to be comfortable with that. Managers deal with organizations, doctors primarily manage individuals.

It starts with the desire to become a better doctor. I believe that learning from both disciplines will achieve this, the doctor-manager.

Combining the two is a matter of expanding your toolbox; better interpersonal skills, change manage-ment, social entrepreneurship, systemic thinking, financial savvy, resource allocation and strategic thought among others. What’s good about it is that the tools you possess as a manager can be applied in the clinical setting.

For a certain diagnostic machine, say a digital X-ray. By relating the daily patient load and prevalent charges to the cost of running the machine, profitability can be determined and compared to an existing analog system.

Efficient patient scheduling can rationalize clinic investment. By relating consultation time, average wait time and patient load per day, turnover time and optimal size of the waiting area can be determined. Because of this, doctors can make do with less space and hospitals can maximize floor area.

At the level of policy-making, cost-benefit and risk analysis can be applied to judiciously allocate limited resources. By doing so, doctor-managers are able to provide service to more people—by being more efficient.

The new breed of doctor is an outstanding clinician; merging the two disciplines; they can be more, a dynamic leader, and a social catalyst.

BA: How do you see Health Plan Philippines, Inc. 25 years from now?

Reyes: I am fond of three point plans, so I will describe my long-term vision in three phases. These will have varied degrees of overlap and at times could be synchronous. First is to re-group as an organization, and with industry, to be a significant contributor in healthcare finance. Second is to rebuild and redefine Philippine healthcare into a system that will be conducive to nation- building. Last is to grow and keep pace with the demand for our much needed nation building efforts. After all, the foundation of a progressive nation is of course a healthy citizenry.

I see Health Plan Philippines, Inc. engaged with industry and government through more collaborative projects such as industry wide adoption of clinical practice guidelines that could lead the way to standardized practices in relation to healthcare financing —bringing together best medical practice with realistic healthcare finance mechanisms fair to the market and healthcare providers.

On a different plane, I can appreciate how the new breed of doctor can make a difference as doctor-managers to define the new state of Philippine healthcare. I envision this happening in all sectors, one organization at time.

BA: So what are your plans for this year? Any big celebration?

Reyes: The marching order is three-fold: 1) Capacity building, 2) documentation and streamlining of internal business processes, and 3) expanding our reach to more of our countrymen through a broader membership base.

Although we have our small successes to celebrate, we are rolling up our sleeves to provide relevant service. We resolve to participate in nation building by “bridging the gap” for a greater number of people.

This has and will continue fuel the change we have undertaken in the organization. That is the plan for this year and the perhaps the next 25 years to come.