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Understanding the Alphabet Soup of Managed Care Integrated Delivery Systems
Structure & Implications
Understanding Different Integrated
Delivery System Models
Robert Hurley, Medical College of Virginia.
Robert Hurley built upon the two previous sessions by presenting a framework for understanding the differences in the
structure, incentives, and implications associated with different managed care integrated delivery system models, including:
- Alternative health maintenance
organizations (HMOs) models.
- Preferred provider organizations (PPOs).
- Point-of-service (POS) plans.
- Provider sponsored organizations (PSOs).
In analyzing these different models and the roles and responsibilities of different parties (e.g., health plans, integrated delivery sponsors,
and individual providers), Dr. Hurley examined the following important questions:
- Which party/parties bear the financial risk?
- Who determines the division of the premium and the
division of labor?
- Who does what and how are they paid?
- How is the system and member flow managed?
This analysis of the different delivery system arrangements that are evolving in the marketplace led a discussion of a
number of key questions for policymakers, including:
- How much reliance on market forces is reasonable
- Where are the key regulatory intervention points
with respect to these new arrangements? At what point does regulation stifle
- How, and from whom, can policymakers get reliable information on the performance of these different systems?
Rovinson JC, Casalino L. Vertical Integration and
Organizational Networks in Health Care. Health Affairs 15(1):7-22.
Hurley RE, Draper DA. Provider-Sponsored Organizations: Are
We Entering the Post-HMO Era? Oncology Issues May/June 1998:18-21.
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