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, establishes primary care provider and specialist responsibilities; and disburses payment to …show more content…
According to an essay published online by the United States Department of Health and Human Services, one of the goals of managed care HMOs contracting with IPAs is to prevent the potential overuse of health care specialists. The traditional HMOs permit access to specialists only with authorization from a primary care provider acting as a gatekeeper. According to a recent study, individuals who have direct access to specialists in their HMOs do not make more visits to specialist than individuals enrolled in gatekeeper HMOs. According to this essay, the rules governing the gatekeeper's role in an HMO may actually encourage additional visits to the primary care physician and to specialists. The rational is simple: the more visits one has to a primary care physician, the more opportunities one has to get a referral to a specialist. Thus, the Managed Care IPA model actually strain rather reduce the strain on both primary care services and the visits made to specialists (Health Care Costs and Financing, 2000). 3. According to an essay published online by the National Cancer Institute, transitional care can be defined as that which is required to facilitate a shift from one stage of care to another. For example, as a disease progresses, a patient may require vastly different levels of treatment within increasingly specialized, costly and comprehensive forms of treatment. For an increasing numbers of patients enrolled in HMOs with a goal of showing a profit,