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Results for “Independent Practice Associations”

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PubMed1988

Health care delivery systems in review.

Physicians are seeking to maintain their practices in the midst of competitive pressures from various delivery systems. However, health maintenance organizations (HMOs) do not have the stronghold they had in the past. Several HMOs discontinued their Medicare risk contracts due to inadequate reimbursement rates, and others experienced financial losses in the October stock market crash. Independent practice associations (IPAs), the most popular HMO type, are particularly plagued by financial problems.

Attitude of Health Personnel↗

PubMed1999

Diabetes in the managed care setting: a prospective plan.

BACKGROUND: As managed care organizations (MCOs) continue to expand into the care of the chronically ill, the concept of providing cost-effective care with a preventive approach is vital for primary care providers (PCPs) to embrace. Diabetes is an ideal disease to incorporate this concept. METHODS: We reviewed the literature using MEDLINE. We used the American Diabetes Association (ADA) Provider Recognition Program guidelines as the foundation for MCOs to establish a diabetes disease management program. RESULTS: The implementation of disease management protocols, the use of computerized management systems, and the team approach can provide cost-effective diabetic care. CONCLUSIONS: To compete in the managed care market, it is vital for providers to link with their Independent Practice Associations (IPA), the ADA, and MCOs to implement standard protocols and negotiate for adequate reimbursement.

Diabetes Mellitus↗

PubMed1988

Hippocrates and the health maintenance organization. A discussion of ethical issues.

Health maintenance organizations (HMOs) are providing an increasing proportion of medical care in the United States. Characteristics of these organizations such as cost containment, incentives to reduce spending by practitioners, and barriers to access for clients raise significant ethical concerns. This paper considers how these features of the HMO withstand ethical scrutiny and what may be done to prevent abuse. Generally, the challenges to the moral integrity of physicians practicing in HMOs are neither intractable nor in all cases unique, although special arrangements may have to be made to ensure that ethical standards are upheld. Independent practice associations pose particular problems. Finally, whether or not an HMO is a for-profit enterprise is a significant consideration.

Clinical Competence↗

PubMedDate not supplied

The routine use of health risk appraisals: results from a national study of physician organizations.

PURPOSE: To document use of health risk appraisals (HRAs) by U.S. physician organizations as part of their overall approach to health promotion and to identify associated organizational characteristics. METHODS: Telephone survey of 1590 physician organizations in the United States; surveys were conducted in organizations comprising 20 or more physicians and were conducted between September 2000 and September 2001 (70% response rate). Chi-square tests and logistic regression analysis were used to examine the association between organizational characteristics and routine administration of HRAs. RESULTS: Only 22.5% of physician organizations in the United States routinely administer HRAs. External quality incentives, information technology capabilities, and status as a medical group vs. an independent practice association are associated with greater odds of the routine use of HRA. DISCUSSION: Increased use of external quality incentives and information technology in physician organizations may be important in supporting the use of HRAs.

Chronic Disease↗

PubMed1991

Information sharing in the managed care setting.

In this article, the author describes how physicians in independent practice associations can benefit from the use of information exchanges and illustrates by describing a method for balancing costs and quality in the managed care setting that was developed via an information exchange.

Communication↗

PubMed1998

Putting managed care in its place.

Take national data on dealings between doctors and hospitals, segment the numbers by the amount of managed care business, and what do you get? A few surprises. In markets highly penetrated by managed care, for instance, fewer hospitals and health systems had arrangements with doctors in salaried groups than with independent practice associations--just the opposite of what you'd expect. That finding and others come by comparing data from the American Hospital Association's 1996 survey of its members with 1996 market information from InterStudy Publications, Bloomington, Minn. In an exclusive to H&HN, researchers at the AHA's Healthcare InfoSource analyzed a sample of 2,837 hospitals, with 894 falling into high-penetration markets, 1,540 into medium markets, and 403 into the low category. Not surprisingly, higher levels of managed care seem to drive more activity between doctors and hospitals. Here's what they found.

American Hospital Association↗

PubMedDate not supplied

Quality assurance in an IPA.

U.S. Healthcare has developed and implemented a state-of-the art quality assurance program building on the strengths of an independent practice association (IPA). The program begins with the criteria for admission of physicians to the plan and extends through recertification and standard setting to linking of compensation to accepted measures of quality of care. This paper describes the components that comprise the quality assurance program.

Independent Practice Associations↗

PubMed1993

Physician negotiations with managed care plans: an antitrust primer.

In negotiating with third-party payers, physicians--whether acting independently or as members of independent practice associations--must proceed very cautiously to prevent antitrust exposure. This article describes a number of government investigations in this area and provides some specific "do's" and "don'ts" for avoiding the appearance of collective action that might be in violation of the antitrust laws.

Antitrust Laws↗

PubMed1994

The appointment-keeping habits of managed care patients.

Among the controversies surrounding the provision of health care in a managed care environment is the belief that patients, because they have no particular allegiance to a single physician, are more casual in regard to their keeping appointments. To test this proposition, the authors conducted a study at a California independent practice association, comparing the habits of managed care patients with those of other types of patients. The findings, although based on a limited sample, suggest that managed care patients do indeed have a greater tendency to be appointment no-shows.

Appointments and Schedules↗

PubMedDate not supplied

Assessing the extent of integration achieved through physician-hospital arrangements.

In this article we examine management service organizations (MSOs), physician-hospital organizations (PHOs), hospital-affiliated independent practice associations (IPAs), and hospital-sponsored "group practices without walls" (GPWWs) that allow physicians to retain their practices and link hospitals and health systems to physicians through contractual arrangements. Also examined were medical foundations (MFs), integrated salary models (ISMs), and integrated health organizations (IHOs) that own the physical assets of physician practices and contract with payors for physician and hospital services. The research provides several new insights for understanding the structure and process of physician-hospital integration. It was found that the extent of processual integration in physician-hospital organizational arrangements can be measured along six dimensions: administrative and practice management services; physician financial risk-sharing; joint ventures to create new services; computer linkages; physician involvement in strategic planning; and salaried physician arrangements. These dimensions are consistent with the conceptual and empirical dimensions developed by others. These findings refute the notion raised by some industry observers that the new physician-hospital organizational models simply formalize integrative activities already in place. Earlier studies from the 1980s reported that hospitals integrated physicians through involvement in governance, capital planning, and the provision of practice management services. In contrast, we found that current integration.

American Hospital Association↗

PubMed1995

Legal issues affecting IPA formation.

Independent practice associations (IPAs) and similar organizations are forming more rapidly as the healthcare industry evolves. The formation of IPAs, however, raises a number of legal issues that must be addressed and resolved, issues related to licensure and choice of entity, antitrust, self-referral, insurance regulations, and liability.

Antitrust Laws↗

PubMedDate not supplied

"Virtual" health care organizations and the challenges of improving quality.

This article examines the challenges of improving health care quality continuously within and across "virtual" provider organizations such as independent practice associations and physician-hospital organizations. It draws on recent research and theory about interorganizational networks in other fields to develop recommendations for securing physicians' commitment to quality improvement strategies in today's health care environment.

Cooperative Behavior↗

PubMed2002

Health plans keeping drug cost increases in check with programs that promote generics.

To counter the massive amount of drug company detailing and marketing that is partly responsible for driving up pharmaceutical costs, health plans and some independent practice associations are promoting the use of generics to physicians in their networks. While most physicians in capitated contracts don't directly benefit from the movement to encourage generics unless they have pharmacy risk, some health plans are paying physicians financial incentives to increase generic prescribing.

Advertising↗

PubMed1987

Capitation in IPA-HMOs. Dealing with financial risks and ethical dilemmas.

Capitation, a relatively new method of payment, is being used increasingly for primary care physicians in independent practice association (IPA) model HMOs. The author explains the actual payment method, including the various amounts withheld, and the financial risks and rewards inherent in this system. He then confronts the sensitive ethical issues posed by capitation. Finally, he offers five sound suggestions for physicians who contemplate joining an HMO that employs capitation.

Actuarial Analysis↗

PubMed1998

A conceptual model of the effects of health care organizations on the quality of medical care.

There has been a great deal of interest in recent years in developing measures of health care quality that can be used to characterize and study the effects of health plans. However, because of the recent emergence of diverse types of health care organizations, it is often difficult to know which parts of a plan should be combined for analysis purposes. Also, simple taxonomies of health maintenance organizations (eg, staff, independent practice associations, group, and network) no longer adequately describe the diverse types of organizations that have become common. In this article we describe these trends, explain why older taxonomies of health care plans are not adequate, and present a new framework for characterizing and studying the effects of diverse types of plans.

Capitation Fee↗

PubMedDate not supplied

Financial incentives and drug spending in managed care.

This study estimates the impact of patient financial incentives on the use and cost of prescription drugs in the context of differing physician payment mechanisms. A large data set was developed that covers persons in managed care who pay varying levels of cost sharing and whose physicians are compensated under two different models: independent practice association (IPA)-model and network-model health maintenance organizations (HMOs). Our results indicate that higher patient copayments for prescription drugs are associated with lower drug spending in IPA models (in which physicians are not at risk for drug costs) but have little effect in network models (in which physicians bear financial risk for all prescribing behavior).

Adult↗

PubMed1998

The use of an integrated clinical laboratory and pharmacy diabetes database to provide physician performance feedback in an IPA-model HMO.

The ability to link pharmacy claims and clinical laboratory result databases in a managed care setting holds great promise as an outcomes management tool. The authors have created a powerful disease management capability that generates dynamic, disease-specific reports containing actionable, provider-patient-level laboratory and pharmacy information. This system is used to send reports to primary care physicians in an independent practice association (IPA)-model managed care setting to improve the care of patients with diabetes mellitus. This systematic feedback methodology can augment physician decision-making behavior, promote compliance with national guidelines, and measure improvement in plan-level, population-based outcomes over time.

Clinical Laboratory Information Systems↗

PubMed1992

Longitudinal analysis of patient satisfaction among Medicare beneficiaries in different models of health maintenance organizations and fee-for-service care.

Based on a randomly selected nationwide sample of Medicare beneficiaries, this study analyzes changes in patient satisfaction over a one year period for beneficiaries receiving care in a variety of delivery settings: fee for service, group model HMO, staff model HMO, and Independent Practice Association model HMO. The findings reveal the patient satisfaction changes significantly over a one year period, from lower levels of satisfaction to higher levels of satisfaction. The primary explanation for this change in satisfaction is a decline in health status over the same one year period. Additional differences in satisfaction with care were observed for Medicare beneficiaries served by different types of delivery settings with varying degrees of utilization controls.

Aged↗