OPPORTUNITIES FOR PHYSICIAN ORGANIZATIONS UNDER MANAGED CARE - Class 3
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Information helpful in forming a primary care group:
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Under managed care, PCP’s assume the role of care manager for a specific group. The opportunity exists for physicians to help ensure that patients receive appropriate levels of care. PCP’s act as allocators of sometimes scarce and usually expensive resources. PCP’s in integrated healthcare systems must balance the roles of patient advocate and appropriate resource allocators, even if those roles seem to conflict.
Proposed Strengths of Individual Practice Associations ("IPAs")
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An opportunity for PCP’s under managed care could be to form or become part of a medical group such as an Individual Practice Association ("IPA"). This medical group could be formed by physicians for physicians where physicians can select to provide a defined range of services from a menu of patient care items.
An IPA might be considered a "Group practice without walls" because it could affiliate a large number of PCP’s and yet the PCP’s maintain their autonomy. The advantage to the PCP might be more leverage in getting managed care contracts and retaining their own practice assets and decision-making powers.
Another opportunity for PCP’s could be to create a Primary care group, add specialists, and get a growing list of patients, and add ancillary services (such as laboratory, radiology, and pathology).
Emerging primary care groups have to recognize that demographic data collection will be crucial to their success and that physicians should obtain community data on the number and types of procedures performed, the demand for specific services and diagnostic tests, the number of physicians in the area, and the concentration of primary care physicians as a percentage of all physicians.
It is indicated that in a managed care environment, the 30% to 40% of every health care dollar that currently goes to hospitals will likely drop to 8% to 10%. Much of the difference could possibly go to PCP’s for managing cost-effective care and to the electronic information systems that will link primary care physicians with specialists and hospitals.
| PCP’s in integrated healthcare systems balance roles of patient advocate and appropriate resource allocators, even if those roles seem to conflict |