Document Type

Report

Publication Date

11-1998

Abstract

This site visit was the second of two focused on managed care operations and market dynamics in California, a state notable for high HMO market penetration and intense competition. In southern California, large physician groups and independent practice associations were highly visible and influential. They had assumed significant financial risk and care management responsibility for patients in HMO plans. The result was a distinctly different model of managed care than existed in other regions of the country. The visit included meetings with leaders from physician organizations and managed care organizations in San Diego and Orange counties, as well as an onsite session at the regional operations center of PacifiCare Health Systems to learn about its Secure Horizons program, the largest Medicare risk plan in the country. Topics included the roles of managed care organizations in this model, their relationships with providers, the ways the physician organizations paid their members and the effects of these compensation methods on clinical decision-making for HMO patients, quality management, and issues related to the transition of beneficiaries under federally funded programs (such as Medicare, Medicaid, and the Children's Health Insurance Program) from fee-for-service to HMO plans.

Comments

Site visit: November 18-20, 1998

Open Access

yes

 
 

To view the content in your browser, please download Adobe Reader or, alternately,
you may Download the file to your hard drive.

NOTE: The latest versions of Adobe Reader do not support viewing PDF files within Firefox on Mac OS and if you are using a modern (Intel) Mac, there is no official plugin for viewing PDF files within the browser window.