Single-specialty carve-outs: a threat to integrated care?

Single-specialty carve-out contracts under capitation are booming nationwide, fueled by economic and practice management incentives. What isn't clear yet is how these arrangements between health plans and physicians will affect integrated health systems, multispecialty group practice-based medical management, and the roles and referral patterns of primary care physicians. For many primary care physicians and multispecialty group leaders, carve-outs represent an economically driven challenge to good medical management. But health plans, and many specialists, argue that carve-outs help patients/plan members, physicians, and the care management process. One's viewpoint on the issue seems to depend largely on the health system interests one has at stake.