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Preferred provider organizations one year later.

G de Lissovoy, T Rice, J Gabel

    Inquiry : a Journal of Medical Care Organization, Provision and Financing
    |January 1, 1987
    PubMed
    Summary
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    The first national survey revealed a distinct "generic" preferred provider organization (PPO) model. A follow-up survey shows continued rapid growth and evolving utilization review in PPOs.

    Area of Science:

    • Health Services Research
    • Healthcare Management
    • Health Economics

    Background:

    • The existence and characteristics of a "generic" preferred provider organization (PPO) were previously unconfirmed.
    • The rapid expansion of PPOs indicated a significant shift in healthcare delivery models.

    Purpose of the Study:

    • To conduct a comprehensive national survey of preferred provider organizations (PPOs).
    • To identify the characteristics of a "generic" PPO model.
    • To assess the growth and evolution of PPOs and their utilization review programs.

    Main Methods:

    • A comprehensive national survey of preferred provider organizations (PPOs) was conducted.
    • A follow-up national survey was completed in September 1986 to track changes.

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    Main Results:

    • The initial survey confirmed the existence of a "generic" PPO with defined characteristics.
    • The follow-up survey indicated continued rapid growth in PPO eligibility.
    • Utilization review programs have intensified, focusing on physician practice patterns.
    • Joint ventures between provider-sponsored PPOs and commercial insurers are increasing.

    Conclusions:

    • Preferred Provider Organizations (PPOs) represent a significant and growing segment of the healthcare delivery system.
    • PPO utilization review is becoming more stringent, impacting physician behavior.
    • Strategic partnerships between PPOs and commercial insurers are a multiplying trend in the healthcare market.