ACP starts up physician-directed networks initiative
Goals are to identify 'best practices,' publish an analysis and develop educational courses
From the May 1997 ACP Observer, copyright © 1997 by the American College of Physicians.
By Kathleen Haddad
ACP is launching an initiative to help members integrate and form their own networks and health plans.
The College's "Physician-Directed Networks Initiative" will focus on internal medicine-based networks, particularly those committed to selective physician panels, quality and utilization management, sharing and adoption of best practices, risk-sharing and, eventually, direct contracting with purchasers. In addition to benefiting members, the initiative will promote the public-policy goal of physician-directed networks as an alternative to large HMOs.
The ACP initiative will take a value-oriented approach, in response to purchaser demand in the marketplace. The popularity of managed care has been largely based on its ability to control costs, and three-quarters of employment-based insurance is managed care. Now, however, purchasers—especially large employer coalitions—are beginning to demand that health plans demonstrate quality and cost management. The success of physician networks will depend on their ability to show these measurements of value.
Physician-directed networks can range from small single or multispecialty groups engaged in risk contracting with HMOs to large multispecialty groups offering their own HMO products and contracting directly with employers and purchasers. According to the AMA's Private Sector Initiative, half the state medical societies have formed or are forming physician-directed networks—either management service organizations that foster local physician networks, IPA models that contract with HMOs, or full insurance products such as the one offered by the California Medical Association. These models tend toward large and inclusive panels.
ACP will identify and publish an analysis of the "best practices" employed by internal medicine physician networks. In addition, the College will develop educational courses to be offered at Annual Session and possibly elsewhere that guide physicians through the integration process.
Both steps will cover topics such as network planning, business plan development, capital resources, panel selection, governance, utilization and quality management, group culture issues, information systems, legal structure, regulatory requirements, contracts, reimbursement methods, licensing, use of consultants, measurement of patient satisfaction, physician-patient continuity and ethical issues. Future projects may involve Web site development, including electronic news and support groups, and other publications.
ACP's initiative, which has been reviewed during the past year by numerous College panels, including the Board of Regents, reflects needs identified in the College's most recent environmental assessment and a 1996 member survey on ACP members' experience with managed care. The Division of Public Policy will spearhead the effort in coordination with the College's Managed Care Resource Center.
The College laid the foundation for this effort in its 1996 position paper, "Physician-Directed Health Plans: A Response to the Corporatization of Medicine." The paper examined the history and benefits of group practice, physicians' need to integrate to cope with consolidation in the health care marketplace, the potential for physician-directed integration to support professional values and the potential for physician-run networks to set marketplace standards of high quality and low cost. n
Kathleen Haddad is Senior Associate for Policy and Communications in ACP's Washington, D.C., office.
Already integrated? We need your help
If you have been through the process of practice integration and network formation, you can make a valuable contribution to the College's Physician-Directed Networks Initiative and to your profession. ACP is launching the initiative to help other physicians integrate and to help protect professionalism in health care.
We are looking for physician-created networks built around internal medicine—single specialty, multispecialty or networks involving both internal medicine and other specialties.
Please send your name—along with the name, size and location of your group—to Kathleen Haddad, 800-633-9400; 700 13th Street, NW, Suite 250, Washington, DC 20005; Khaddad@acponline.org
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