There appears to be consensus on the fact that information on individual providers or facilities, and on “health plans” alone is insufficient when the relationships between these entities are varied and complex. Physicians perceive that more functional responsibilities are assumed at the group or physician organization level by large multi-specialty groups, medical IPAs, physical management organizations and other entities. Hospitals perceive the importance of systems of care and point out the complex ways in which these entities relate to their medical staff and others in the provider and health plan community. For example, a given hospital may be part of one or many health care systems. It could also sponsor an HMO or contract with several HMOs and other managed care entities for a diverse set of products. Each relationship would bring different but overlapping sets of physician affiliations. An individual physician may participate directly in that hospital’s HMO, may be part of a group that contracts with other managed care entities, and may be part of a management entity (e.g., an independent practice association) that also contracts with managed care entities. Each of these entities may, in turn, contract with a variety of managed care plans, sometimes directly and sometimes through other entities. Furthermore, many of these relationships are unstable, and the relative importance of different levels of aggregation may vary across and within markets as well as over time. Given this situation, it is not clear how to capture any consistent and universally useful data on these arrangements over time or even at one point in time. Furthermore, the absence of knowledge in this area contributes to difficulties in developing better performance measures.
- Suggestion #2a. Convene a working session of individuals and groups who have been struggling with these issues, including AHCPR staff, policy research staff associated with groups including AAHP, AMA, AHA, AAMC and NCQA, and researchers active in developing new frameworks and techniques in this area (such as Jeff Alexander, Steve Shortell/Gloria Bazzoli, Robert Miller/ Hal Luft, Joseph Newhouse, Paul Ginsburg/Robert St. Peter, Bob Hurley/Marsha Gold) to review perceptions of current needs, work in progress upon which to build, and important next steps.
- Suggestion #2b. Initiate follow-up efforts to develop both a taxonomy to address these issues and a set of recommendations for national and state data collection priorities in terms that address concerns for the conceptually appropriate units for collecting
information and the techniques which need to be used to generate inventories of such units for use by the broad industry, policy, and research communities.
- Suggestion #2c. Plan to initiate follow-up activity that appears warranted from the proceeding suggestions. At a minimum, information should be disseminated to states or public/private consortiums that would focus on these issues. Potentially, there may be inventories that are best developed at the federal level alone or through a public-private partnership.