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Related Experiment Videos

Beyond competition

R A Berenson

    Health Affairs (Project Hope)
    |March 1, 1997
    PubMed
    Summary
    This summary is machine-generated.

    Managed care organizations and provider networks are often similar. Quality improvement efforts should involve provider groups and utilize market-compatible consumer protections like disclosure and risk adjustment to reward high-quality care.

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    Area of Science:

    • Health Services Research
    • Health Economics
    • Quality Improvement

    Background:

    • Managed care organizations (MCOs) often lack clear differentiation in organizational characteristics.
    • Provider networks within competing health plans tend to be nearly identical due to employee demand for broad choice.
    • In markets with numerous undifferentiated networks, existing quality improvement strategies may be overly intrusive and ineffective.

    Purpose of the Study:

    • To propose alternative strategies for quality improvement in managed care.
    • To address the challenges posed by undifferentiated provider networks.
    • To recommend market-compatible methods for protecting consumers and incentivizing quality care.

    Main Methods:

    • Conceptual analysis of managed care market dynamics.

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  • Review of current quality improvement approaches.
  • Economic analysis of financial incentives and risk adjustment.

    • Main Results:

    • Current quality improvement methods can be intrusive in undifferentiated markets.
    • Delegating quality improvement to provider groups and fostering collaboration are suggested.
    • Capitation for cost containment is inevitable, necessitating careful management of financial incentives.

    Conclusions:

    • Health plans should shift quality improvement responsibilities to provider groups.
    • Market-compatible consumer protections, including expansive disclosure and risk adjustment for premiums and capitation, are essential.
    • These measures can effectively reward high-quality care within managed care settings.