Evaluating HMO/IPA contracts for family physicians: one group's experiences
Cook, J.V.; Rodnick, J.E.
Journal of Family Practice 26(3): 325-331
1988
ISSN/ISBN: 0094-3509 PMID: 3126260 Document Number: 312926
This article reports the experience of a 15-person primary care group with two health maintenance organization/independent practice association (HMO/IPA) contracts. In 1986 the group received over $1.5 million in capitated payments from the plan to cover medical care of approximately 4,000 patients. The expenses exceeded the income for one plan. Analysis of primary care, specialty care, and ancillary services provides insight into factors that must be considered in evaluating HMO/IPA contracts. Eleven questions that should be asked before signing contracts and guidelines for utilization review and quality assurance are reviewed.