All too often, the fundamentals of a sport, industry or discipline are learned at the early stages but then forgotten as an individual advances in knowledge and sophistication. And that, according to Joe Anderson, is the problem that has caused so many healthcare headaches over the years.

The most basic assurance of high quality and low cost, according to the CEO of Phoenix-based Schaller Anderson, is to provide the right care, at the right time, in the right place-in other words, care management. But health plans have gotten away from that fundamental rule during their search for "the next great thing."

"Ensuring that physicians are using evidence-based medicine in their practices is the key to better outcomes in a patient population, and too many companies have just decided to give up and stop doing that," he said during an interview in the company's corporate headquarters. "That's the blocking and tackling of healthcare, and it's hard work. But it's the best way to ensure quality care and the lowest possible costs."

In two of Anderson's most prized success stories, focusing on the nuts and bolts of healthcare has resulted in tremendous achievements.

"Companies get away from basic managed care strategies and then call us when they get into trouble."

"If you're willing to get involved, it's amazing what kind of results you can achieve," he says. "Many times, you end up doing even more good than you anticipated in the first place."

In the driver's seat Schaller Anderson began as a consultancy in 1986 and still offers consultative services today. However, both Anderson and his co-founder, Dr. Don Schaller, became frustrated by companies' seeming disinterest in taking their advice to heart.

"We could see people's eyes glaze over when we gave them our suggestions," Anderson says, "so we decided to go out and find some management contracts."

Part of the reason that clients' eyes "glazed over" was because the advice Anderson and Schaller gave involved hard work and-once again-getting back to the basics of management. Advocating concepts such as prior authorization might have been common in the heyday of the tightly managed HMO, but it has fallen far out of favor with most health plans because of consumer demand for greater choice and freedom in their healthcare decisions. Anderson, however, remains a champion of such basic managed care techniques.

"What our industry has found so challenging is executing basic managed care principles properly. Prior authorization, for example, is not a barrier to care; it's a system that does many positive things. If a PCP learns that a patient in his care is going to have knee surgery, he can ensure that the patient is trained on the use of crutches before the surgery occurs. Without prior authorization, the PCP usually wouldn't even know that surgery was scheduled.

"Companies get away from core managed care strategies and then they call us once they get into trouble and don't know how to get out of it," he says. "For example, plenty of health plans do telephonic review, but that's just not good enough. We do concurrent review every day of the week. We have our nurses right there in the hospitals, where they review charts, talk to the physicians and help the patients arrange follow-up care. In the larger institutions, we send physicians in as well. Some payers ask nurses to deny care, but we'd never do that. When it comes to deciding whether or not a patient is ready to be moved out of intensive care, only the attending physician can make that decision."

The biggest rewards Despite the experience he's gained over the years, Anderson has no trouble identifying the two accomplishments he is most proud of. Although he has a degree in Sociology and a professional background in operations analysis and research, Anderson got his start in government in 1970, and one of his proudest achievements happened during that time.

In 1984, he was working for Arizona's governor, Bruce Babbitt, who asked him to help lead the re-engineering of Arizona's Health Care Cost Containment System (AHCCCS), the nation's first statewide Medicaid program based on managed care principles. The vendor that had been managing it on behalf of the state told Gov. Babbitt that unless given a substantial pay increase, it would terminate its involvement with AHCCCS in 30 days.

"A colleague and I told the governor to let them go and we'd do it ourselves" Anderson says. "In 28 days, we set up a state agency, hired 140 employees, transitioned all of the software onto state computers, and never missed a beat. One of the world's biggest technology companies told the governor it would take six months to do the transition, but we did it in four weeks."

Over the next 30 months, Anderson and Dr. Schaller reorganized AHCCCS, converting it from an often-criticized agency into one that now has been copied, either in whole or in part, by more than three dozen other states.

Anderson's second great success story involved perinatal services, which often are the greatest area of risk for Medicaid plans. The company was administering one such plan, and a hospital executive-who saw Schaller Anderson's employees doing the tireless work of prior authorization and concurrent review in his facility on a daily basis-asked them to help improve their perinatal services.