Chapter 6: How Healthcare is Organized Part II
What was prepaid group practice changed to? When?
- In 1970s, prepaid group practice was renamed to HMOs
Who is the largest HMO?
Kaiser permante
What is a multispecialty group practice?
collaborative style of care where colleagues share responsibility for care of patients
What is vertical integration?
consolidating under one organizational roof all levels of care and the facilites and staff necessary to provide this full spectrum
What type of payment do PPOs use? HMOs?
fee for service, pre paid
What did prepaid group practice meld together?
financing and delivary of care
What is a stepping stone to vertical integration?
horizontal integration
Integrated health care increases or decreases quality of care?
increases
How does HMOs differ from traditional insurance?
insurance plan only pays for services provided by those physicians and hospitals in the HMO plan
Which perform better at delivering preventative care: integrated medical groups or IPAs?
integrated groups
How was virtual integration involved with IPAs?
involves contractual links between HMOs and physician groups, hospitals, and other provider units
How does HMO model differ from prepaid group practice?
it is more loosely integrated
What is medicare shared savings program in direct relationship with?
medicare advantage
What were the two seeds of medical care structures?
multispeciality group practice and community health centers
When were community health centers developed? What did they emphasize?
o Early 1900s, emphasized primary and preventative care with a focus on public health nurses
What is oligopoly in the hospital world?
o Hospitals are consolidating into larger more horizontally integrated systems that limits competition due to the market being taken up - also drives up health care cost
How is Kaiser horizontally integrated?
o Kaiser also is horizontally integrated, as they consolidated health care units providing the SAME type of servies
Why do provider groups form ACOs?
o Provider groups form these in order to be able to participate in a reformed payment model that places phyiscians and hospitals at shared financial risk with the payer for a global bugetdary target for a population of patients
What is an ACO?
o Provider led organization whose mission is to manage the full continumm of health care and be accountable for the overall costs and quality of care for a defined population
When were community health centers revived and by what?
o Was revived in 1965 by federal office of Economic Opportunity's War on Poverty
Why did Medicares traditonal payment method (fee for service) not work?
o provided little incentive for physicians and hosptials to collaborate to achieve health care quality goals
What was an alternative to the traditonal small office, fee for serve practice?
pre-paid group practice
What does the premium serve as in prepaid group practice?
serves to directly purchase in advance services
How is Kaiser vertically integrated?
they have their own health insurer, hospitals, and providers
What are IPAs?
§ A network model of horizontal integration that brough together doctors in private offices to gain more favorable contracts with insurance companies
Why were IPAs created?
§ Created in hopes to reduce costs to employers and would choose IPA over Kaiser
What are the goals of community health centers?
§ Goals to develop multidisciplinary teams to provide health services and allow for governance of the center by community members, and to help improve health status of low income communities
How are IPAs paid? How are the physicians paid within the IPA?
§ Insurers pay the IPA, which then pays the physician
What is a PPO?
· Plans have a preffered network but does allow you to see providers outside of org, but have to pay more out of pocket
What is virtual integration?
· an integration of services based on contractual obligations rather than unitary ownership
