Managed Care Delivery Systems
Introduction: According to Terence Shea in an article published by HR Magazine (2005), in the last fifty years, employers' health cost have soared as coverage has expanded and medical care has been revolutionized. Since the early 1980s, there have been a number of governmental and corporate attempts to slow this dramatic rise in health care expenditures. Most health plans in the U.S. today involve some form of managed care. Nearly 90 percent of Americans with health insurance are covered by HMOs and other managed-care plans. The reason for the shift from the traditional to managed care plans was to hold down healthcare costs. As HMOs grew physicians in private or small group practices have become less common (Shea, 2005).
1. According to an essay published online by the California Medical Association, an Individual Practice Association (IPA) is a type of Health Maintenance Organization (HMO). The IPA contracts with individual health care practitioners or an association of individual medical doctors and other health care practitioners to provide health care services in return for a fee. IPAs generally include large numbers of individual private practice physicians. The IPA compensates health care providers on a per capita fee, or on some other agreed basis for compensation (Individual Practice Association, 2003).
IPA health care providers practice in their own offices and can continue to also see fee for service patients. An IPA is a legal entity organized and directed by physicians in private practice to negotiate contracts with insurance companies on their behalf. Participating physicians are usually paid on a capitated or modified fee-for-service basis. An IPA can exert influence on be half of its members to counterbalance the leverage of health care insurers. An IPA organizes the delivery of care, negotiates contracts with insurance companies; credentials and inspects member physicians,... [continues]
Introduction: According to Terence Shea in an article published by HR Magazine (2005), in the last fifty years, employers' health cost have soared as coverage has expanded and medical care has been revolutionized. Since the early 1980s, there have been a number of governmental and corporate attempts to slow this dramatic rise in health care expenditures. Most health plans in the U.S. today involve some form of managed care. Nearly 90 percent of Americans with health insurance are covered by HMOs and other managed-care plans. The reason for the shift from the traditional to managed care plans was to hold down healthcare costs. As HMOs grew physicians in private or small group practices have become less common (Shea, 2005).
1. According to an essay published online by the California Medical Association, an Individual Practice Association (IPA) is a type of Health Maintenance Organization (HMO). The IPA contracts with individual health care practitioners or an association of individual medical doctors and other health care practitioners to provide health care services in return for a fee. IPAs generally include large numbers of individual private practice physicians. The IPA compensates health care providers on a per capita fee, or on some other agreed basis for compensation (Individual Practice Association, 2003).
IPA health care providers practice in their own offices and can continue to also see fee for service patients. An IPA is a legal entity organized and directed by physicians in private practice to negotiate contracts with insurance companies on their behalf. Participating physicians are usually paid on a capitated or modified fee-for-service basis. An IPA can exert influence on be half of its members to counterbalance the leverage of health care insurers. An IPA organizes the delivery of care, negotiates contracts with insurance companies; credentials and inspects member physicians,... [continues]
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