Understanding the Alphabet Soup of Managed Care Integrated Delivery Systems

Structure & Implications

Understanding Different Integrated Delivery System Models

Robert Hurley built upon the two previous sessions by presenting a framework for understanding the differences in the structure, incentives, and implications associated with different managed care integrated delivery system models, including:

• Alternative health maintenance organizations (HMOs) models.
• Preferred provider organizations (PPOs).
• Point-of-service (POS) plans.
• Provider sponsored organizations (PSOs).

In analyzing these different models and the roles and responsibilities of different parties (e.g., health plans, integrated delivery sponsors, and individual providers), Dr. Hurley examined the following important questions:

• Which party/parties bear the financial risk?
• Who determines the division of the premium and the division of labor?
• Who does what and how are they paid?
• How is the system and member flow managed?

This analysis of the different delivery system arrangements that are evolving in the marketplace led a discussion of a number of key questions for policymakers, including:

• How much reliance on market forces is reasonable and prudent?
• Where are the key regulatory intervention points with respect to these new arrangements? At what point does regulation stifle innovation?
• How, and from whom, can policymakers get reliable information on the performance of these different systems?

References

Rovinson JC, Casalino L. Vertical Integration and Organizational Networks in Health Care. Health Affairs 15(1):7-22.

Hurley RE, Draper DA. Provider-Sponsored Organizations: Are We Entering the Post-HMO Era? Oncology Issues May/June 1998:18-21.

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