Medical savings accounts. Power and choice

As the market becomes more saturated and matures, keeping people healthy will become a bigger source of profits and true health maintenance will become increasingly important. Right now, however, the name of the game is restricting services, particularly in new markets. What is sorely needed is a balance between the individual and organizational agendas, between the individual and society. There is a tremendous opportunity for hospital-physician groups contracting directly with employers using Medical Savings Accounts (MSAs) and catastrophic insurance as a core strategy. Are MSAs a viable insurance vehicle? Some argue that those enrolled in MSAs will put off receiving needed medical care. But it can also be viewed that MSAs, by their very nature, put costs back into the negotiation phase between patients as customers and physicians and hospitals as providers--and save money and resource consumption as patients shop around for competitive prices to do what needs to be done.

Management services organization for group practices

This article analyzes why management service organizations (MSOs) have become the major interface between group practices and managed care organizations as well as their advantages and disadvantages. It provides this information in the context of The University of Texas Southwestern Medical Center's development and operation of an MSO in the Dallas/Fort Worth market.

CEO summit. A new breed

A new breed is evolving in health care. A provider sponsored network i s part insurance function and part provider function. But no one knows exactly how it will behave. In the second entry of the exclusive four-part CEO Summit series planned by McManis Associates and cosponsored by H&HN, some top leaders in health care discuss some of the conflict in this changing delivery system.

Trends in American medicine: problems for the defense expert

American medicine is undergoing an unprecedented upheaval in its relationship with government, third party payers, business and professional groups, with its patients, and most of all within itself. These trends take the form of movements away from specialization which had been increasing until just recently; the introduction of practice criteria and practice guidelines; the virtual elimination of fee for service medicine; the creation of multiple physician health care organizations working in managed competition; and the grouping of doctors into provider organizations offering credit lines to health care systems. These trends, along with decreasing reliance on tissue diagnosis, declining support of medical research and ever-expanding health care teams have definite impact on the issue of negligence. The foregoing is an attempt to define these and to make some educated guesses as to their impact on health care delivery in the United States in the next several years and the ways in which the negligence climate is likely to change.

A new way of thinking: how managed care networks will affect physician and hospital marketing efforts

The formation of integrated delivery networks will cause physicians and hospitals to rethink their marketing strategies. As providers align themselves into networks in conjunction with managed care plans, new approaches to marketing will be employed.

Integration: opportunities and issues for medical group practices

McManis Associates, a health care management consulting firm, recently gathered several medical group practice leaders for an informal discussion of integration and other key trends affecting medical groups. The goal of this "Forum for Medical Group Practice Leaders" was to elicit candid discussion among a small group of executives (who are in key positions in medical group practices), identify some of the key strategic issues they are facing and encourage them to share their opinions and experiences. The forum participants come from diverse backgrounds, a wide range of geographic locations and many different types of professional settings, including a single specialty medical group; independent, physician-owned multispecialty groups; an integrated medical center with its own hospital; the physician component of a large, integrated, multi-hospital system; and the leadership of the Medical Group Management Association (MGMA). The discussion was facilitated by Gerald L. McManis, president of McManis Associates, Inc., Louis Pavia Jr., senior vice president, and F. Kenneth Ackerman Jr., FACMPE, principal associate with the management consulting firm. This article provides a summary of the forum's proceedings, and the executive views and opinions of some of the key issues and challenges facing medical group practices today, including integration initiatives, governance, access to capital, critical success factors for group practices, as well as trends and projections for the future.

Follow the money

Like a torrent cutting its way to the main riverbed, investor capital is moving relentlessly into the physician practice business. It rolls on without any concern for the traditions that created the deep revenue pools of hospitals, specialists, and insurance companies--except for an irrepressible need to drain them.

PHOs fall short of expectations. Despite failings, networks may have role as a transition to vertical integration

An estimated 3,000 physician-hospital organizations have formed since the early 1980s, most of them in the last two years. But their slow progress in managed-care contracting has many wondering if they're anything more than an expensive fad. Proponents argue that despite their failings, PHOs may have a role as a transition to vertical integration.

Reasons providers form PHOs

According to a recent survey, providers form physician-hospital organizations (PHOs) to improve their contracting positions with managed care organizations, to facilitate collaborative efforts with physicians, and to enhance their abilities to accept and manage capitation. The survey also revealed that PHOs are still in their infancy and operate amid regulatory uncertainty as they develop the expertise and infrastructure necessary to successfully compete in a managed care environment.

MSOs: key to PHOs and community-based health care systems

In the '50s and '60s, as you drove through the United States, you could not help but notice the large number of mom and pop businesses--gas stations, groceries, restaurants. The same ride in the '70s and '80s is remembered because of the large number of these businesses that had closed their doors. In the '90s, this could very well begin to happen to doctor's offices and small clinics as medicine comes to look more and more like a business. This decade has already seen a shift in medicine from fee-for-service to more managed types of insurance and payment programs and the beginning of larger physician groups. Proposed health reform initiatives can only serve to accelerate these trends. Those in medicine prepared for changes will survive and perhaps even thrive. The others will wither on the vine. One of the key strategies that will enhance survival is cooperation and organization among the different players--hospitals, insurance companies, and providers. An extremely valuable tool for survival, along with the independent practice arrangement, the integrated delivery system, etc., will be the management service organization.

Health care's power brokers in the 21st Century. Interview by Donna Vavala

Health care has undergone turbulent change in the 20th Century. In addition to dramatic pharmaceutical and technological advances, the entire health care delivery system has been significantly improved. Through all the turmoil, hospitals have been at the center of the health care universe. But, as the 21st Century approaches, that may change, too. What will become of hospitals, which for most of this century have played a commanding role? Will managed care organizations and group practices come out on top? And, once the new power broker takes over, what will be the impact on providers, insurers, and the government, and how will their relationships to each other change? Jeff Goldsmith, PhD, President of Health Futures, Inc., Bannockburn, Ill., and health care futurist, examines tomorrow's health care delivery system and makes some eye-opening predictions.