PubMed Health⌕ Search

Biomedical subjects

J Unland

Publications and source records attributed to J Unland.

5 recordsLinked to original sources
PubMed1995

Hospitals versus physicians, POs versus PHOs: the providers' struggle for control of managed care contracting.

The great majority of U.S. hospitals are at one stage or another of physician-hospital organization (PHO) formation, in an attempt to accomplish hospital-physician integration. Since early 1994, however, significant numbers of physicians have begun to form their own organizations and confederations. The physician organization (PO), a more highly evolved form of the independent practice association, usually covers a wide geographic area, and it can cross hospital boundaries. Founders of the PO nearly always wish to position the organization to negotiate "master contracts" directly with payers and employers, rendering hospitals mere subcontractors. This article examines the evolution of physician attitudes about PHOs and POs, and also gives insight into the details of PO formation. The author outlines barriers to PO formation, and draws a picture of a momentous industrywide struggle for control between physicians and hospitals.

Capitation Fee↗
PubMed1994

Surviving stress.

Explore the source record for details and available documents.

Health Care Reform↗
PubMed1993

Group practices and hospital affiliation of medical practices.

Federal reimbursement systems, state constitutional amendments, and fiscal responsibilities are driving physicians and hospitals into alliances that were unheard of a decade ago. How those alliances are established is critical to the success of those new affiliations. James Unland explores several forms of physician groups and physician-hospital alliances. The "Group Practice Without Walls," "The Mutual Service Corporation" and others are explored in this article. In a world of changing health-care programs, Unland states there is a middle ground where group-practice ownership and control are shared. The exact type of structure, ownership, and control will depend upon many factors. Unland makes a point-by-point evaluation of a hospital-group alliance that integrates numerous medical practices into a single operational entity.

Costs and Cost Analysis↗
PubMedDate not supplied

New opportunities for provider/insurers. Catholic healthcare organizations are well positioned for direct contracting.

Congress and a number of state governments have recently taken steps to encourage the formation of provider/insurer networks and other forms of "direct contracting" by providers with consumers. No group is better positioned than Catholic hospitals and medical centers, with their common heritage, not-for-profit status, and history of community service, to take advantage of direct contracting opportunities. Provider/insurer configurations fall into three categories: self-policing networks that assume full-risk contracts from payers; joint ventures between provider networks and existing insurance companies or HMOs; and provider networks that establish their own insurance capability. Anticipated changes in many states' insurance application processes will make it easier for providers to choose the latter option. The keys to a successful provider/insurer plan are differentiation from other insurance products in the market and a strong, consumer-friendly image. The involvement of physicians is vital, and the majority of physicians on any one hospital's staff should be members of the provider/insurer network. Currently, the Medicare population, rather than the commercial sector, is a good choice for a beginning provider/insurer network to cover. While such networks may be driven by either physicians or hospitals, a joint initiative by physicians and hospitals is preferable. Successful implementation of highly evolved medical management systems and related operational support is also key.

Catholicism↗