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National Information Center on Health Services Research and Health Care Technology (NICHSR)

HSRProj (Health Services Research Projects in Progress)

Information about ongoing health services research and public health projects


Arrangements between managed care plans and physicians
(Archived Project)
Investigator (PI): Gold, Marsha; Hurley, Robert
Performing Organization (PO): (Current): Virginia Commonwealth University
Supporting Agency (SA): Physician Payment Review Commission (PPRC)
Initial Year: 1993
Final Year: 1996
Record Source/Award ID: HSR/0
Award Type: Cooperative Agreement
Data Source: Survey of managed-care plans
Number of Subjects: 108
Population Base: Managed-care plans in the United States
Study Population: Randomly selected HMOs and PPOs in 20 urban markets nationwide
Abstract: The project's objective is to study the arrangements managed-care plans make with physicians. The study focuses on how physicians are selected and credentialed by various managed-care plans; how plans pay physicians and the kinds of financial incentive systems created to influence practice patterns; how plans monitor physicians care and use utilization management and quality improvement methods and techniques. An extensive telephone survey of 108 plans (78 percent response rate) was conducted between June and November 1994. Results from the survey were published by the Physician Payment Review Commission in February 1995. The second phase of the project includes seven site visits to surveyed plans and additional analysis of survey data. The site visits helped validate the information collected in the survey and allowed an exploration of certain issues in greater depth. Additional analysis considered plans' use of different products, the importance of markets, and the role of intermediate entities between plans and providers. A final report will be published by the Commission in 1996.
MeSH Terms:
  • Managed Care Programs /*organization & administration
  • Practice Management, Medical /economics
  • /*organization & administration
  • Total Quality Management
  • United States
  • Utilization Review
Keywords:
  • research support, non-U.S. Gov't
Country: United States
State: Virginia
Zip Code: 23298
UI: 19960001
Project Status: Archived