Building And Managing Effective Physician Organizations Under Capitation

Note: Supplemental materials are not guaranteed with Rental or Used book purchases.

ISBN: 9780834208094 | 0834208091
Cover: Paperback
Copyright: 8/9/1996

Buy Used

Usually Ships in 2-4 Business Days

$422.59
Buy New

Print on Demand: 2-4 Weeks. This item cannot be cancelled or returned.

$566.35

This resource offers you a unique Building Block system, a proven-effective tool used by organizations to survive and prosper in an era of different reimbursement schemes, from discounted fee-for-service and primary care capitation, to global capitation and percent of premium payment.

Contributors

(2)

Acknowledgments

(2)

Introduction--Taking Leadership To Restructure Health Care Delivery

xiii

Part I--Creating the Physician Infrastructure

(100)

Chapter 1--Building Effective Physician Equity Alliances and Organizations

(30)

Douglas Goldstein

Hank Fanberg, M.B.A.

Introduction

(1)

From Medical Practice to Physician Equity Alliance

(2)

Six Types of Physician Equity Alliance

(20)

Profiling Management Services Organizations as a Central Element

(4)

Understanding Evolving Physician Organizations

(2)

Today's Market Competition Demands Action and Merger

(2)

Chapter 2--System Building Blocks To Manage Capitation

(25)

Douglas Goldstein

Introduction

(1)

Integrated Communications and Information Systems

(4)

Process Measures and Outcomes Reporting

(4)

Multispecialty Physician Networks

(1)

Demand Management and Disease Management Systems

(5)

Continuous Quality Improvement and Clinical Reengineering

(1)

Internet and On-Line Services

(5)

Cost Reduction and Cost Management

(1)

Preventive Medicine and Empowered Consumers

(2)

Physician and Executive Leadership

(1)

Chapter 3--Strategies for Communicating with Physicians in the Era of Health Care Restructuring

(14)

Matthew J. Lambert III, M.D., M.B.A.

Introduction

(1)

Market Dynamics and the Role of Communications in Integration

(5)

Communication Strategies for Integration

(8)

Empower Communication Plan and Physician Leadership

(1)

Chapter 4--The Five Stages of Managed Care and Physician Organizations

(15)

Russell C. Coile Jr., Ph.D.

Introduction

(1)

PHOs--Are They Working and Will They Last?

(1)

Twenty-First-Century Health Reform Will Be Physician-Led

(1)

Five Stages of Managed Care

(8)

Three Scenarios for Integration

(2)

Alternative Paths to Integration

(2)

Chapter 5--Using Advanced Physician Management Structure To Ensure Clinical Effectiveness

(14)

Steven S. Lazarus, Ph.D., F.H.I.M.S.S

John Lucas, M.D.

Executive Summary

(1)

Introduction

(1)

The LHS Implementation of Advanced Physician Management

(3)

The Lovelace Physician Group Population Health Model of Medical Delivery

(3)

Information Requirements To Support Advanced Physician Management

(4)

Information Systems

(2)

Conclusion

100

(1)

Part II--The Merger and Expansion Process

101

(88)

Chapter 6--Expansion Process for Physician Organizations

103

(24)

Douglas Goldstein

Introduction

103

(1)

Conducting Action-Oriented Research

104

(3)

Pursuing Aggressive Business Development

107

(1)

Understanding the Equity Transaction

108

(3)

Using an Aggressive Business Expansion Process

111

(13)

Implementing and Enhancing Systems for Growth

124

(3)

Chapter 7--Structuring a Physician Compensation Plan That Rewards Performance in the Managed Care Environment

127

(17)

Mark Buchanan, M.D.

Introduction

127

(1)

Getting Started

128

(1)

Criteria for a Compensation Plan

128

(1)

Building Blocks for a Compensation Plan

129

(5)

Stories from the Front Lines

134

(2)

Four Scenarios for Income Distribution

136

(3)

General Comments on the Four Plans

139

(1)

When Is Change Appropriate?

140

(1)

Income Division and the Patient

141

(1)

Conclusion

142

(2)

Chapter 8--Capital and Equity Issues in Physician Organizations and Practice Management Industry

144

(17)

Douglas Goldstein

E. James Streator III

Introduction

144

(1)

Market Realities of the Physician Practice Management Industry

144

(1)

Expansion of the Physician Practice Management Industry

145

(4)

Physician Take Leadership

149

(1)

Financial Issues and Capital Sources Related to Growth

150

(3)

Financial Implications of Strategic Alliance Options

153

(6)

Strategic Alliance Decisions

159

Chapter 9--Legal Issues in Organizing and Expanding Physician Organizations

161

(28)

Philip B. Belcher, J.D.

S. Rogers Warner Jr., J.D.

Introduction

161

(1)

Integrated Group Practice--Merger of Medical Groups

161

(11)

Independent Practice Association

172

(7)

Other Affliations

179

(10)

Part III--Advanced Information Systems Issues

189

(40)

Chapter 10--Selecting Information Systems for Managing MSOs and Large-Scale, Integrated Ambulatory Networks

191

(14)

Mary de Lourdes Winberry, M.P.H.

Introduction

191

(1)

A Look at the Big Picture

192

(1)

Infrastructure Needs

193

(4)

Selecting an Information System

197

(4)

Staying Competitive

201

(4)

Chapter 11--Managing the Planning and Start-Up Operations for Advanced Practice Management Information Systems

205

(12)

Steven S. Lazarus, Ph.D., F.H.I.M.S.S.

Executive Summary

205

(1)

Introduction

205

(1)

Planning the Information Systems

206

(2)

Major Information Systems Applications

208

(1)

Information Systems Budget and Financial Considerations

208

(2)

Conversion to a New Information System

210

(3)

Managing Change

213

(1)

Value Added

214

(1)

Anticipating Future Needs

215

(1)

Conclusion

216

(1)

Chapter 12--Applying Outcomes Research To Increase Quality

217

(12)

Sanford R. Hoffman, M.D.

Mary de Lourdes Winbery, M.P.H.

Introduction

217

(1)

History of Outcomes Research

217

(1)

Outcomes Research Today

218

(1)

Outcomes Data--What Are They?

219

(1)

Gathering the Data--The Survey

220

(1)

Utility Assessment--Patient Preferences

220

(1)

Accountability--Its Impact on Practice Guidelines

221

(1)

Once You Have Outcomes Measurements, What Do You Do with Them?

221

(1)

Who Is Collecting the Data?

223

(1)

Diease Management

223

(1)

The Demand for Outcomes

224

(1)

Getting Started

224

(1)

Future Trends

225

(4)

Part IV--Managing Managed Care and Capitation

229

(78)

Chapter 13--Managed Care Contracting and Reimbursement for Physician Organization in a Capitated and Risk-Sharing Environment

231

(20)

Richard Ferreira, M.D., J.D.

Introduction

231

(1)

Contracts

231

(10)

Reimbursement Methodologies for Managed Care

241

(7)

Risk Sharing

248

(3)

Chapter 14--Legal Issues Associated with Managed Care Contracting

251

(27)

Irwin M. Birnbaum, J.D.

Executive Summary

251

(1)

Legal Issues Important to Competitive Policies and Procedures

251

(12)

Understanding the MCO Contract

263

(13)

Conclusion

276

(2)

Chapter 15--Critical Issues in Negotiating Capitated Contracts

278

(29)

Kerry McDonald

Introduction

278

The Business Environment

278

(1)

Preparing for Negotiations

279

(1)

Strategy for the Negotiations

280

(1)

Negotiating the Lenguage

280

(6)

Negotiating the Rate

286

(7)

Preparing the Organization for Capitation Negotiations

293

(7)

Conclusion

300

(1)

Appendix 15-A--Cost System Definitions

301

(2)

Appendix 15-B--Variable Costing Income Statement Format

303

(1)

Appendix 15-C--Data Sources, Elements, and Specific Statistics

304

(3)

Part V--Taking Leadership

307

(46)

Chapter 16--Developing and Operating Physician-Driven HMOs

309

(8)

John Pollard, M.D.

Introduction

309

(1)

Basic Requirements

310

(1)

Initial Steps

311

(2)

Start-Up

313

(1)

Operational Issues

314

(2)

Operational Issues

314

(2)

Conclusion

316

(1)

Chapter 17--Organizing and Managing Specialty Networks for Capitaion

317

(21)

Richard W. Krohn, M.B.A.

Introduction

317

(1)

Specialty Networks--Development and Strategic Choices

317

(3)

The Framework of Specialty Risk Contracting

320

(1)

Making Risk Contracting Work in Specialty Networks

321

(2)

Understanding the Capitation Contract

323

(3)

Infrastructure Requirements of Successful Risk Contracting

326

(2)

Success Factors of Risk-Based Specialty Networks

328

(3)

The Bottom Line--What Specialists Should Expect from Their Network

331

(3)

A Successful Specialty Carve-Out Network--SalickNet

334

(3)

Winning through Adaptation

337

(1)

Chapter 18--Multispecialty Physician Organizations: The New Force in Medicine

338

(10)

Nancy McDermott

Charles Hollander, M.D.

Richard Garber, M.B.A.

Steven Wolfson, M.D.

Introduction

338

(1)

The Benefits of a Multispecialty Organization

339

(1)

Creating Multispecialty Organizations

341

(5)

Bridging the Gap Between Primary Care Physicians and Specialists

346

(1)

New Relationships Sprouting from Multispecialty Organization Development

347

(1)

Summary

347

(1)

Chapter 19--Creating the Future through Today's Vision and Actions

348

(5)

Douglas Goldstein

Introduction

348

(1)

Competitive Advantage through System Building Blocks

348

(1)

Track Tends and News in the External Environment

349

(1)

Competitive Advantage through Thinking and Leadership

350

(3)

Index

353

Please wait while the item is added to your bag...

FREE SHIPPING

Amazon no longer offers textbook rentals. We do!

Building And Managing Effective Physician Organizations Under Capitation

Summary

Table of Contents

Supplemental Materials