Creating a competitive PSO: a case study.

Abstract

Mount Carmel Health System, an integrated delivery system in Columbus, Ohio, became a Medicare+Choice contractor in response to unsatisfactory payment proposals from the Medicare contractors it serviced and to compete with the increasing number of managed care providers in its market. To meet HCFA's operational requirements, Mount Carmel upgraded and expanded its administrative and health information systems and solicited the support of its network physicians. It also developed a marketing strategy to promote its health plan. In the two years after instituting its provider-sponsored organization, Mount Carmel surpassed its original enrollment projections, decreased its patient management and utilization costs, and increased payments to its network members.