New UCSF Study Asks: Do Physicians & Patients Fare Better Under Physician-Run Managed Care Groups?

May 19, 1998

The trend in California under managed care is to delegate more responsibility to physician groups, but it is not yet clear whether this shift will be advantageous for physicians or patients, according to a new study by health policy specialists at the University of California San Francisco.

The UCSF team surveyed physician groups throughout the state that provide health care through an organizational structure known as an independent practice association, or IPA. Study findings are published in the new issue (May/June) of the journal Health Affairs.

An IPA consists of a network of physicians who agree to participate in an association to contract with health maintenance organizations (HMOs) and other managed care plans. The role of the IPA is to serve as an intermediary between managed care plans and individual office-based physicians, with both the practicing physicians and HMOs retaining their corporate independence from the IPA.

"We found that physician-run IPAs look a lot like HMOs and other managed care organizations administered by 'business professionals' in terms of how they deal with physician staffing, payment, and related policies," says Kevin Grumbach, MD, study principal investigator and associate professor in the UCSF Department of Family and Community Medicine based at the UCSF-affiliated San Francisco General Hospital.

"It remains to be seen if physicians and their patients will fare differently--for better or for worse--under 'MD managed care' than they do under 'MBA managed care,'" he adds.

"IPAs are popular in the West, especially in California, because this model makes it possible for physicians to maintain ownership of their practices and administer their own offices. But these groups experience the same types of competitive pressures as other forms of managed care," says Grumbach, who also holds appointments as research director of the UCSF Center for the Health Professions and director of the UCSF Center for California Health Workforce Studies.

The UCSF study is based on data analysis from a 1996 survey of 53 California IPAs, representing more than half of all patients and physicians in IPAs statewide. The IPAs averaged two specialists for every primary care physician in their networks.

The research team acknowledges that the study was limited by its focus on only one state, but adds that California is regarded as a trendsetter for many managed care phenomena and results from a California sample may indicate trends in the wider IPA market.

Study findings centered on three major areas--staffing, payment patterns, and governance. They include:
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University of California - San Francisco

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