Toward a behavioral model of the physician as case manager

The search for means to contain rising health care costs has increasingly focused on the physician's key role in resource consumption decisions. A particularly explicit example of this is the new wave of interest in public and non-public programs which designate a primary care physician to be a 'physician case manager'. This title seems to reflect an attempt to assign and impute to the physician functions and responsibilities significantly beyond traditional clinical duties. This paper explores the multiple functions of the physician to develop a behavioral model of the physician case manager. This model is employed to identify a series of practice style orientations (PSOs) which represent differing emphases given to the core functions physicians are required to perform. Strong physician case management is characterized as those PSOs in which the rationer/resource allocator function is emphasized. The paper concludes by suggesting what types of external pressures and incentives may be useful in fostering strong case management.