The New Structure of Individual Practice Associations

Abstract

There are two types of HMOs: prepaid group practices (PGPs) and individual practice associations (IPAs). Because of rapid change in the HMO industry, the academic literature, which is based primarily on data from the 1970s, is dated in several ways. The literature has focused on PGPs, but IPAs are growing three times faster than PGPs and are likely to dominate the HMO industry in the near future. The literature indicates that a small proportion of an IPA physician's practice is capitated, but such practices often are as much as one-third capitated. And while the literature indicates that IPA physicians are rarely given financial incentives to control cost, such incentives are now common. In this decade IPAs have cut their hospital days per thousand enrollees. Furthermore, IPAs in which individual physicians or medical groups bear some of the financial risk of hospital costs appear to have the same rate of hospital days as PGPs. Additional research is especially needed on cost and quality of care in modern IPAs.

Razing a Tower of Babel: A Taxonomy for Managed Care and Health Insurance Plans

“…Other researchers have developed innovative taxonomies for classifying the different HMO types (Zelten 1979(Zelten , 1981Welch et al 1990;Welch 1987).…”

Defining educational priorities in managed care

“…The delivery of managed care is no longer dominated by group and staffmodel HMOs, but rather takes place predominantly in private physician offices and medical group practices. 8,11 In addition, organized delivery systems are emerging as a growing model for health care delivery. 12 Further, with the rapid growth of decentralized health plans, there is little clarity about the distribution of responsibilities-and attendant accountability-between physicians and plans.…”

Quality Assurance in Capitated Physician Groups

“…Thus, monitoring for overuse meets both QA and utiliza¬ tion management needs. Second, the complexity of the analytic task may have (5)(6)(7)(8)(9)(10)(11)(12)(13)(14)(15)(16)(17)(18)(19) a dramatic impact on where attention is focused. For example, monitoring per¬ formance of services that have already occurred (eg, number of angioplasties performed) is a simpler analytic task than determining which services were not performed but should have been (eg, the proportion of eligible women who did not receive a mammogram).…”