title: Independent practice associations and physician-hospital organizations can improve care management for smaller practices.
abstract: Pay-for-performance, public reporting, and accountable care organization programs place pressures on physicians to use health information technology and organized care management processes to improve the care they provide. But physician practices that are not large may lack the resources and size to implement such processes. We used data from a unique national survey of 1,164 practices with fewer than twenty physicians to provide the first information available on the extent to which independent practice associations (IPAs) and physician-hospital organizations (PHOs) might make it possible for these smaller practices to share resources to improve care. Nearly a quarter of the practices participated in an IPA or a PHO that accounted for a significant proportion of their patients. On average, practices participating in these organizations provided nearly three times as many care management processes for patients with chronic conditions as nonparticipating practices did (10.4 versus 3.8). Half of these processes were provided only by IPAs or PHOs. These organizations may provide a way for small and medium-size practices to systematically improve care and participate in accountable care organizations.
authors.affiliation: Department of Public Health, Weill Cornell Medical College, New York City, NY, USA. lac2021@med.cornell.edu
authors.forename: Lawrence P
authors.initials: LP
authors.lastname: Casalino
authors.forename: Frances M
authors.initials: FM
authors.lastname: Wu
authors.forename: Andrew M
authors.initials: AM
authors.lastname: Ryan
authors.forename: Kennon
authors.initials: K
authors.lastname: Copeland
authors.forename: Diane R
authors.initials: DR
authors.lastname: Rittenhouse
authors.forename: Patricia P
authors.initials: PP
authors.lastname: Ramsay
authors.forename: Stephen M
authors.initials: SM
authors.lastname: Shortell
mesh_terms: D002908:Chronic Disease / Q000628:therapy; D003695:Delivery of Health Care / Q000458:organization & administration / Q000706:statistics & numerical data; D018166:Health Care Reform / Q000458:organization & administration; D006302:Health Services Research; D006759:Hospital-Physician Joint Ventures / Q000458:organization & administration* / Q000706:statistics & numerical data; D006801:Humans; D007193:Independent Practice Associations / Q000458:organization & administration* / Q000706:statistics & numerical data; D008511:Medicine / Q000458:organization & administration / Q000706:statistics & numerical data; D010346:Patient Care Management / Q000458:organization & administration*; D010818:Practice Patterns, Physicians' / Q000458:organization & administration / Q000706:statistics & numerical data; D058996:Quality Improvement / Q000458:organization & administration* / Q000706:statistics & numerical data; D058012:Small Business / Q000458:organization & administration* / Q000706:statistics & numerical data; D014481:United States; D014600:Utilization Review
keywords: Business Of Health; Chronic Care; Health Reform; Legal/Regulatory Issues; Organization And Delivery Of Care