A National Survey of the Arrangements Managed-Care Plans Make with Physicians

Gold, Marsha; Hurley, Rosalinde; Lake, Timothy; Ensor, Tim; Berenson, Robert A.

doi:10.1056/nejm199512213332505

Cited by 236 publications

(111 citation statements)

References 7 publications

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“…Our data thus provide a snapshot of the industry at this point in time. Of the studies noted earlier, the only one that is close to ours in terms of questions asked and sampling frame is Gold et al (1995). Insofar as Gold et al's results can be compared with ours, they appear broadly consistent with them.…”

Section: Together With the American Association Of Health Plans (Aahpsupporting

confidence: 85%

Managed Care: An Industry Snapshot

Buntin¹

2002

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Section: Together With the American Association Of Health Plans (Aahpsupporting

confidence: 85%

Managed Care: An Industry Snapshot

Buntin¹

2002

INQUIRY

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“…Provider networks used by managed care plans are complex, with individual plans typically using many different types of provider contracts (Gold, Hurley, Lake, et al 1995;InterStudy 1997a;1997b). In 1994, half of all HMOs (and two-thirds of PPOs) contracted with physicians, both directly through individual contracts and indirectly through various forms of intermediate entities (Gold, Hurley, Lake, et al 1995). Most often, these contracts were with groups and provider IPAs, but almost half the HMOs (and a smaller share of PPOs) had contracts with physician-hospital organizations (PHOs).…”

Section: Increased Health Plan Focus On Network-based Deliverymentioning

confidence: 99%

“…These network IPAs are made up of independent providers in communitybased practices. In 1994, however, 55 percent of group-staff model HMOs made some use of network IPA arrangements within their traditional HMO product (Gold, Hurley, Lake, et al 1995).…”

Section: Increased Health Plan Focus On Network-based Deliverymentioning

confidence: 99%

The Changing US Health Care System: Challenges for Responsible Public Policy

Gold

1999

Milbank Quarterly

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The “managed care backlash” arguably topped the list of media and policy concerns in 1998. Yet, against the background of the highly charged environment in which the future of our health care system continues to be debated, there is a dearth of concrete, “objective” facts on the nature of the changes, the reasons for them, and their meaning. An analysis of five important themes that emerged from a review of the recent literature on health system change concludes that an inherent tension exists between the interest in rapidly driving down health care costs through organizational change and the long time frames that are required to make fundamental changes in structure, process, and orientation. Unfortunately, in an environment in which purchasers are driven to seek cost savings and the political will supports a pluralistic and mixed public/private system, the health system may chart an alternative course, with the result that purchasers may rely increasingly on individual cost sharing and continue to cut back the amount of coverage they are willing to offer. The real challenge for public policy makers is to confront the issues directly, avoiding political incentives to adopt easy and fast solutions for these complex matters.

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“…Some plans are already taking such steps. Of the managed care plans responding to a 1994 national survey, 46 percent reported adjusting payment to primary-care physicians for quality measures, 36 percent for consumer surveys, and 21 percent for enrollee turnover rates (Gold et al 1995). …”

Section: Payment For Physician Servicesmentioning

confidence: 99%

Increased Competition and the Quality of Health Care

Sisk

1998

Milbank Quarterly

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P r o p o n e n t s o f i n c r e a s e d p r i c e c o m p e t i t i o nwish to improve the efficiency of the health care marketplace by strengthening attention to costs among health care decision makers. The call for greater price competition arose during a period of rapidly rising expenditures, when providers and consumers, as well as employers and third-party payers, paid scant regard to the cost implications of their decisions. The intention was that decision makers would weigh costs as well as benefits in choosing among health care and other goods and services and among alternative strategies to manage health problems.As cost consciousness has grown, however, so has public concern about threats to the quality of care that is being delivered. This situation is reminiscent of the adage that we may get what we wish for. Nothing inherent in the concept of efficiency or increased price competition predicts that the quality of care will be improved, or even maintained, at past or current levels. Besides the quality of care, consumers and others value certain amenities and styles of practice. Our national and individual values concerning equity may also temper the drive for quality and efficiency. With increased price competition, the

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A National Survey of the Arrangements Managed-Care Plans Make with Physicians

Abstract: Managed-care plans, particularly HMOs, have complex systems for selecting, paying, and monitoring their physicians. Hybrid forms are common, and the differences between group or staff HMOs and network or IPA HMOs are less extensive than is commonly assumed.

Cited by 236 publications

References 7 publications

Managed Care: An Industry Snapshot

Managed Care: An Industry Snapshot

The Changing US Health Care System: Challenges for Responsible Public Policy

Increased Competition and the Quality of Health Care

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