How to integrate your practice into the new health care system

In the evolving health care delivery paradigm, physicians manage overall health status rather than illness, and providers rather than insurance companies bear the risk. Consequently, interest in prevention--long of prime interest to pediatricians--is increasing among all providers. The ethical practice of medicine in a managed care environment involves providing care at a level that avoids high cost with poor outcomes. High cost with poor outcomes can be the result of either undertreatment or overtreatment. Purchasers of health care today are clear about what they want--low cost, convenient access for their employees, medically appropriate, documented treatment, and patient satisfaction--and they are clear about how they intend to get what they want. Different areas of the country are at different stages in the evolution of managed care. Physicians who practice in markets that are still in early stages must plan ahead, taking the lead in shaping the changes that are occurring and preparing their practices for managed care. Otherwise, someone less concerned about quality of care will shape them. Solo or small group practices will survive, but those that survive will not be independent. The necessary affiliation with larger entities does not mean that clinical autonomy and freedom must be sacrificed.