Health Affairs Looks at California Physician Groups and Capitation Payments
The new issue of Health Affairs features four studies examining physician groups in California and the effect of capitation rates. Here's a quick look at the reports, with links when possible:
- "Reevaluation Of Capitation Contracting In New York and California": This study analyzes data from Aetna U.S. Healthcare and six physician organizations in California and New York to examine changes in the "scope of capitation contracting and delegation of responsibility for claims payment and medical management" between 1998 and 2000. The study was conducted by James Robinson, a professor of health economics at UC-Berkeley's School of Public Health, and Lawrence Casalino, a professor at the University of Chicago's Department of Health Studies. While California and New York have "stood at opposite ends of the managed care continuum," with California physicians signing capitation agreements and New York physicians mainly entering into fee-for-service contracts, researchers found a "movement" in both states "to reduce the scope of prepayment and a rethinking of the delegated contractual relationship by physician organizations and health plans" -- the reverse of what was predicted in the 1990s (Robinson/Casalino, Health Affairs, July/August 2001). The full report is available at http://www.healthaffairs.org/2004Robinson2.pdf. Note: You will need Adobe Acrobat Reader to view the study.
- "Physician Organization In California: Crisis And Opportunity": This report, also written by Robinson, examines the 250 doctors' groups that provide care for California HMO enrollees, and finds that even in their earlier years, when they were successful, "medical groups in California were not the panacea described by their protagonists." He adds, "Today, at their nadir, they are not nearly as fragile as claimed by their antagonists." He writes that the outcome of the current debate about managed care and doctor groups "will have important implications not only for the largest state in the union but for the nation as a whole, since it will frame a generation of attitudes towards the role, if any, of physician organization" in the U.S. health care system (Robinson, Health Affairs, July/August 2001).
- "Canaries In A Coal Mine: California Physician Groups And Competition": In this report, Casalino examines the ways policy decisions affect competition among California physician groups, finding that public and private policy decisions "do not manage competition in optimal ways" because they "reward groups for market leverage and controlling costs while failing to fully reward quality and efficiency" (Casalino, Health Affairs, July/August 2001).
- "Scale And Structure Of Capitated Physician Organizations In California": This report, written by Meredith Rosenthal, Richard Frank, Joan Buchanan and Arnold Epstein, all from the Harvard School of Public Health, provides an in-depth examination of the various capitation arrangements that California physician groups have entered into with health plans. The study finds that doctor groups "appear to have responded to capitation by affiliating with hospitals and management companies, adopting hybrid organizational structures and consolidating into larger entities" (Rosenthal et al., Health Affairs, July/August 2001).
This is part of the California Healthline Daily Edition, a summary of health policy coverage from major news organizations. Sign up for an email subscription.