The first comparative report of health plan performance produces surprising revelations — and a starting point for assessing a plan's quality. But some people caution not to read too much into the numbers alone.
Michael D. Dalzell
Contrary to many experts' predictions, per-member, per-month prepayment of managed care physicians isn't sweeping the nation. But it can't be counted out, either.
Between fee-for-service payment and pure capitation, health plans are developing several alternative means of paying specialists. So-called "contact capitation" is one of them.
Will global capitation be the means of reducing HMOs to the status of third-party administrators? Experts differ on that one. But they agree that capitation, in its various forms, is here to stay.
It didn't take a seer to predict that states would try managed care on their costliest health mandate. But only a seer today can be sure whether physicians will be able to live with Medicaid risk contracts.
History has vindicated Paul Ellwood's prediction of a price-competitive health care market. Is he right again in saying the current trend away from integration will be reversed?
Zeneca Pharmaceuticals convened a roundtable of five experts in August to discuss the transformation of Medicare into a more flexible, multi-option system that loosens restrictions on physicians. They paid particular attention to the changes just enacted in the Tax Reform Act of 1997.
Way back when, credentialing was something done only by hospitals. Now, nearly every health plan must do a check on every physician. The AMA has a plan to lighten the burden. But will it work for all parties?
John La Puma, M.D.
Neil Caesar, J.D.
Managed Care Outlook