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Independent No More:
How Effective Have Physician Organizations Been in Responding to Managed Care?
Wednesday, January 27, 1998
Paul B. Ginsburg, President, Center for Studying Health System Change
At this roundtable hosted by HSC, panelists will offer their perspective on what is motivating physicians to move from small practices into larger organizations and what they hope to achieve by forming these organizations. Although much experimentation has taken placedriven mostly by physician desire to regain leverage with health plansno model of physician organization has emerged as unambiguously successful. In fact, many modelsamong them medical groups, IPAs, MSOs and PHOshave not been able to deliver care more effectively or have not proved to be financially successful for doctors or their sponsors.
The roundtable participants will discuss what has gone wrong for these organizations and why, as well as highlight any areas where organizations have achieved success. This diverse group which includes consultants, practioners and researchers will also discuss their views about how physician organizations will evolve in the future, given the demands of employers and consumers, regulatory changes and the introduction of new technologies.
Topics to Be Covered Include:
How have organizations financed their formation? Which of the various approaches has proven successful over the longer term, from the perspective of the physicians and sponsoring organization? How might Physician Organizations financing needs be changing?
What kinds of governance structures have these physician organizations set up and what are the implications for delivery of care?
What objectives are they trying to achieve through their contracting relationships? How have these evolved? How are regulations - such as the Stark law prohibiting self-referrals and anti-kickback laws, among others - influencing the contracting environment?
How are physicians approaching medical management within these various organizations? Why are some organizations integrating care delivery processes with their hospital and ancillary provider counterparts, while others are carving out populations or disaggregating care in other ways? Which approaches are optimum for physicians and patients?
These broad topics will be considered by the panelists against the backdrop of three organizational scenarios provided to the conference attendees. These scenarios will be located in three of the 12 communities that HSC is studying intensively to understand how the health system is changing and the implications of those changes on consumers. HSC also conducts surveys every two years in those 12 communities as well as 48 others, which enables HSC to provide both a national and a market perspective about health system change.
The last part of this conference will be devoted to a discussion about what attributes the optimum physician organization should possess and how external demands by purchasers, consumers and regulators may shape the physician organization of the future.
Who Should Attend:
Policymakers who need to have a current understanding of how physician organizations are evolving and how regulation is shaping that evolution.
Industry leaders who would like to understand the range of objectives that physician organization are attempting to achieve by forming these organizations, where they are succeeding or failing and why that is the case.
Employers, and their proxies, who may themselves be considering contracting directly with physician organizations or want a better understanding of how they operate.
Researchers who would like a current national perspective about the evolution of physician organization as well as examples from local markets.