Provider organizations at risk: A profile of major risk-bearing intermediaries, 1999

Health Affairs

Volumn 20, Issue 2, 2001, Pages 175-185

  Gold, Marsha R ^a   Hurley, Robert ^b   Lake, Timothy ^c  

^a MATHEMATICA POLICY RESEARCH   (United States)

^b VIRGINIA COMMONWEALTH UNIVERSITY SCHOOL OF MEDICINE   (United States)

^c MPR ^*

Author keywords

[No Author keywords available]

Indexed keywords

ARTICLE; CAPITATION FEE; FINANCIAL MANAGEMENT; HEALTH CARE DELIVERY; HEALTH MAINTENANCE ORGANIZATION; INFORMATION PROCESSING; ORGANIZATION AND MANAGEMENT; RISK MANAGEMENT; UNITED STATES;

CAPITATION FEE; CONTRACT SERVICES; DATA COLLECTION; HEALTH MAINTENANCE ORGANIZATIONS; PROVIDER-SPONSORED ORGANIZATIONS; RISK SHARING, FINANCIAL; UNITED STATES;

EID: 0035286985     PISSN: 02782715     EISSN: None     Source Type: Journal    
DOI: 10.1377/hlthaff.20.2.175     Document Type: Article

References (14)

1. J.C. Robinson and L. Casalino, "Vertical Integration and Organizational Networks in Health Care," Health Affairs (Summer 1996): 7-22; G.J. Bazzoli et al., "A Taxonomy of Health Networks and Systems: Bringing Order Out of Chaos," Health Services Research 33, no. 6 (1999): 1683-1718; L. Burns et al., "Managed Care Process to Integration Physicians/Hospitals," Health Care Management Review 23, no. 3 (1998): 70-80; J. Krawlewski et al., "The Organizational Structure of Medical Group Practices in a Managed Care Environment," Health Care Management Review 23, no. 2 (1998): 76-96; and R. Miller, "Health Systems Integration: A Means to an End," Health Affairs (Summer 1996): 92-106.
2. J.C. Robinson and L. Casalino, "Vertical Integration and Organizational Networks in Health Care," Health Affairs (Summer 1996): 7-22; G.J. Bazzoli et al., "A Taxonomy of Health Networks and Systems: Bringing Order Out of Chaos," Health Services Research 33, no. 6 (1999): 1683-1718; L. Burns et al., "Managed Care Process to Integration Physicians/Hospitals," Health Care Management Review 23, no. 3 (1998): 70-80; J. Krawlewski et al., "The Organizational Structure of Medical Group Practices in a Managed Care Environment," Health Care Management Review 23, no. 2 (1998): 76-96; and R. Miller, "Health Systems Integration: A Means to an End," Health Affairs (Summer 1996): 92-106.
3. J.C. Robinson and L. Casalino, "Vertical Integration and Organizational Networks in Health Care," Health Affairs (Summer 1996): 7-22; G.J. Bazzoli et al., "A Taxonomy of Health Networks and Systems: Bringing Order Out of Chaos," Health Services Research 33, no. 6 (1999): 1683-1718; L. Burns et al., "Managed Care Process to Integration Physicians/Hospitals," Health Care Management Review 23, no. 3 (1998): 70-80; J. Krawlewski et al., "The Organizational Structure of Medical Group Practices in a Managed Care Environment," Health Care Management Review 23, no. 2 (1998): 76-96; and R. Miller, "Health Systems Integration: A Means to an End," Health Affairs (Summer 1996): 92-106.
4. J.C. Robinson and L. Casalino, "Vertical Integration and Organizational Networks in Health Care," Health Affairs (Summer 1996): 7-22; G.J. Bazzoli et al., "A Taxonomy of Health Networks and Systems: Bringing Order Out of Chaos," Health Services Research 33, no. 6 (1999): 1683-1718; L. Burns et al., "Managed Care Process to Integration Physicians/Hospitals," Health Care Management Review 23, no. 3 (1998): 70-80; J. Krawlewski et al., "The Organizational Structure of Medical Group Practices in a Managed Care Environment," Health Care Management Review 23, no. 2 (1998): 76-96; and R. Miller, "Health Systems Integration: A Means to an End," Health Affairs (Summer 1996): 92-106.
5. J.C. Robinson and L. Casalino, "Vertical Integration and Organizational Networks in Health Care," Health Affairs (Summer 1996): 7-22; G.J. Bazzoli et al., "A Taxonomy of Health Networks and Systems: Bringing Order Out of Chaos," Health Services Research 33, no. 6 (1999): 1683-1718; L. Burns et al., "Managed Care Process to Integration Physicians/Hospitals," Health Care Management Review 23, no. 3 (1998): 70-80; J. Krawlewski et al., "The Organizational Structure of Medical Group Practices in a Managed Care Environment," Health Care Management Review 23, no. 2 (1998): 76-96; and R. Miller, "Health Systems Integration: A Means to an End," Health Affairs (Summer 1996): 92-106.
6. P. Elkind, "Vulgarians at the Gate: How Ego, Greed, and Envy Turned MedPartners from a Hot Stock into a Wall Street Fiasco," Fortune (21 June 1999): 132-145; R. Lowes, "The PPM Meltdown: How FPA's Implosion Buried Its Doctors," Medical Economics (25 January 1999): 140-155; and L.R. Burns et al., "The Fall of the House of AHERF: The Allegheny Bankruptcy," Health Affairs (Jan/Feb 2000): 7-41.
7. P. Elkind, "Vulgarians at the Gate: How Ego, Greed, and Envy Turned MedPartners from a Hot Stock into a Wall Street Fiasco," Fortune (21 June 1999): 132-145; R. Lowes, "The PPM Meltdown: How FPA's Implosion Buried Its Doctors," Medical Economics (25 January 1999): 140-155; and L.R. Burns et al., "The Fall of the House of AHERF: The Allegheny Bankruptcy," Health Affairs (Jan/Feb 2000): 7-41.
8. P. Elkind, "Vulgarians at the Gate: How Ego, Greed, and Envy Turned MedPartners from a Hot Stock into a Wall Street Fiasco," Fortune (21 June 1999): 132-145; R. Lowes, "The PPM Meltdown: How FPA's Implosion Buried Its Doctors," Medical Economics (25 January 1999): 140-155; and L.R. Burns et al., "The Fall of the House of AHERF: The Allegheny Bankruptcy," Health Affairs (Jan/Feb 2000): 7-41.
9. Among the sixty-five contracts, forty were global risk, twenty-three were professional services risk, and two were hospital risk contracts; the latter are included in the total but not identified separately. The health plan survey shows that hospital risk contracts are by far the least common. The analysis presents unweighted data to describe organizations and contracts.
10. Of the thirteen reporting a difference in risk between reference contract and others, five said that both sets had the same amount of risk, five said that other contracts had more risk, and three said that they had less.
11. Only 16 percent of health plans with global risk contracts and 20 percent of those with professional services risk contracts said that they delegated responsibility for quality assurance to their largest intermediate entity.
12. Consumer Assessment of Health Plans (CAHPS): Fact Sheet, Pub. no. 00-P-047, 1 April 2000, (19 December 2000).
13. See M. Gold et al., Health Plans' Selection and Payment of Providers, 1999 (Washington: MedPAC, May 2000), 149.
14. The eight leaning toward discontinuing the Medicare contract had much smaller Medicare enrollments than those likely to maintain the contract (average 3,157 versus 17,718) and were much more likely to rate their satisfaction with the reference health plan as 4 or lower.