Lessons from the trenches in physician integration

Beyond the theoretical basis for integration, three core considerations stand out as the primary reasons for pursuing integration from a physician's perspective. In the authors' experience, the ability to make a case for physician integration stands or falls based on the ability of the integrated delivery system to address these considerations: Gain greater access to capital; develop human resources with talents in managed care and the full spectrum of care services; and sustain an information infrastructure. This article explores the lessons learned in pursuing physician integration.     

Elements of the American Health Security Act of 1993

Over the past several decades, there has been a plethora of proposals that were developed in response to the ongoing debate on how best to solve the problems of the American health care delivery system. In the past decade, calls for modification of our health system have become even more resonant, as measures to control rising costs were unsuccessful and access to basic services was diminished for many Americans. The most recent addition to the list of proposals for modifying the health care system is the American Health Security Act of 1993, introduced by President Clinton in September 1993. This article will examine the position of the Clinton Administration on health reform and the core elements of the reform package.     

Health reform for small population areas

There has been criticism of the managed competition model in terms of its impact on rural areas. It is suggested that the approach simply won't work for providers in rural areas and that an adjustment will be necessary. The author, acknowledging the flaw, proposes changes that will make competition work better for all providers. This column is jointly edited by Kevin M. Fickenscher, MD, and David A. Kindig, MD, PhD, chair and member, respectively, of the College's Forum on National Health Policy. Dr. Fickenscher is participating in various advisory capacities on health care in the Clinton Administration, and Dr. Kindig is Senior Advisor to HHS Secretary Donna Shalala.     

Designing np control charts

This paper presents the results of a simulation approach to the design of economic attribute control charts. The approach taken differs from the classical studies reported in the literature in two respects. First, the often made assumption that the out-of-control state of a process will remain so until detection is relaxed. This in effect allows the average proportion of defectives to deteriorate further before the out-of-control state is detected. Second, there is no requirement for detailed information on the exact process behaviour in the out-of-control state. It is assumed that a multitude of out-of-control causes exist and that the proportion defective is equally likely to be within a specified range of values. The relaxation of these two assumptions makes the model realistic and gives it wide practical applications in the control of a manufacturing process. The simulation computer programs developed are sufficiently compact to run on the low cost microcomputers.     

Elements and strategies of an effective provider integration strategy

Regardless of the outcome of the debate in our nation's capitol, a health care revolution is sweeping the nation. In fact, if the debate lasts much longer, policy makers will be playing catch-up and responding to policies already in place in the trenches. Everywhere we turn as health care leaders, there is evidence of major change on the horizon. Reimbursement methodologies are undergoing radical alteration, traditionally stable institutions are being challenged, new organizational models are evolving, the types and roles of providers best suited to provide care are being questioned, and consumer expectations are being heightened. One of the basic strategies that is receiving attention throughout the country as a response to all this change relates to the development of integrated delivery organizations (IDO), integrated delivery systems (IDS), or integrated delivery networks (lDN). This article discusses these emerging systems in terms of health care reform, describes the rationale for their creation, and provides some strategies for their successful development.