Today, with physician and hospital reimbursement being cut and tied to quality incentives, physicians and health plans are revisiting the concept of integration. Payers are demanding that the industry do more with less without sacrificing quality of care. As a result, physicians again find themselves integrating and aligning with hospitals that have the resources they lack or must develop together.

Written by an acknowledged expert in the field of physician integration and managed care contracting, Physician Integration & Alignment: IPA, PHO, ACOs, and Beyond examines physician integration and alignment in the current healthcare market. It outlines the common characteristics of integrated groups and various organizational structures, and also explains how you can avoid making the same mistakes of the past. Filled with suggestions and ideas from successfully integrated practices, the book:
Identifies industry drivers for the resurgence of integrated models and the need for aligned models Provides a look at the common characteristics of integrated and aligned groups and how the components can work together Discusses antitrust and other regulatory concerns present when considering the right organizational and management structure Offers time- and money-saving checklists, lessons learned, models, and templates—saving you thousands of dollars in consulting fees

Maria K. Todd provides readers with the vision and practical tools needed to organize their business entities in a manner that will maximize economic clout and provide quality of care for both the hospital and physician group. This much-needed resource includes helpful insights on topics such as declining physician reimbursement, declining margins, physician shortages, physician-hospital competition, rising practice investment requirements, the return to capitation as a payment mechanism, and recent changes in the relationships between physicians and health systems.

Maria currently is the principle of the largest gintegrated health delivery system in the world with over 6,000 hospitals and 85,000 physicians spanning 95 countries. She has developed more than 200 integrated and aligned IPAs, PHOs, ACOs, MSOs and healthcare clusters in her career.

Contents

INTRODUCTION TO PROVIDER ORGANIZATIONS

The Goals and Objectives of Physician Alignment and Integration: Form Follows Function

Independent Practice Associations (IPAs)

Second-Generation IPAs

Step 1

Step 2

Step 3

Step 4

Financing and Managing the IPA

Picking Your Consultants

Operations Management for the IPA

Administrative Staffing for the IPA

Governance Issues for the IPA

Start-Up Capital

Solvency Standards

The Steering Committee

The Bylaws Committee

Membership Committee

Utilization Management Committee

Quality Assurance (QA) Committee

Finance Committee

Cred...