Shared Services Cooperatives: A Qualitative Study by Christina Clamp Eklou Romaric Amendah & Carol Coren

Author:Christina Clamp, Eklou Romaric Amendah & Carol Coren
Language: eng
Format: epub
Publisher: Oak Tree Press

%

Insurers

*25

Hospitals

40

Primary Care Physicians

11

Specialists

11

Ancillary Costs

9

Pharmacy

4

* Based on Don McCormick’s audit reports of managed care programs for a 15-year period.

** Includes expenses and profits representing 10% to 15% of gross premiums received; 33% of these profits are paid out as performance bonuses to participating physicians.

The IPAs are the first step in the creation of these cooperatives. The model requires 1,500 to 2,000 patients with 30 primary care physicians in the association. In addition, the group needs two specialists in each of 15 specialty categories: cardiology, general surgery, neurology, ophthalmology, podiatry diagnostic radiology, hospitalist, ob / gyn, otolaryngology, pulmonology, gastroenterology, nephrology, orthopedic surgery, pediatrics, and urology. Other sub-specialists are contracted such as cardiovascular surgery, oncology and neuro-surgery. The delivery model for the cooperative in Texas also includes nurse practitioner services for patients that cannot or will not go to the physician’s office. Patients over 65 should see their physician five times per year based on current practices in Europe, Japan and the United States. Younger patients need to be seen less frequently (McCormick, 2011, p.38).

Figure 3.3: A Heuristic Model of Inter-organization Collaboration in the Patient Physician Cooperatives

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