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The relative emphasis upon physician practice and organizational affairs of a consumer council in a prepaid group practice health plan.

This paper examines the topics of interest to a consumer advisory council in the Health Insurance Plan of Greater New York, a prepaid group practice. Data are derived from observations of consumer council meetings. Topics considered by the council dealt with (a) health plan services, (b) health plan structure, and (c) consumer council structure, process, and organizational role. The council was primarily interested in retaining and expanding existing services, facilitating utilization of services by enrollees, and achieving broader enrollee representation on the board of directors. These interests are directed toward the organizational context within which care is provided and do not relate to physician-patient encounters. Individual enrollees in prepaid group practice may be concerned with the physician-client relationship but consumer representatives are concerned only with the organization-client relationship.

Community Participation↗

Capitating physician group practices.

To prepare for capitated payment, physician group practices must gather essential data on service utilization and cost of services, must develop appropriate compensation and incentive plans for physicians, and must analyze and, if necessary, modify their practices's clinical and business operations. Those group practices that take these steps will be positioned to profit from capitated payment.

Capitation Fee↗

Consumer focus can spur group practice turnaround.

Many healthcare organizations have lost money on their employed group practices. The solution to this dilemma is not necessarily divestment of the group practices. Instead, some healthcare organizations should view their physicians as an asset. Healthcare organizations and physicians need to develop a new framework for their relationship to optimize their competitive advantage. Three guiding principles that will help accomplish this objective are to recast the healthcare organization-physician relationship to focus on the consumer, reconfigure the economic model to exceed consumer demands, and restructure the group practice to encourage fiscal and service excellence. In developing a new relationship framework, the stakeholders need to define the group practice's mission, strategic direction, composition, infrastructure, compensation model, and structure.

Delivery of Health Care, Integrated↗

Hospital/physician relations. How to manage and improve ties with group practices.

As doctors increasingly choose to enter group practices, hospitals must find new ways to build and maintain good relationships with physician groups. Hospitals should go beyond standard communication and relationship-building techniques and surprise their group physicians with innovative services, such as direct-to-bed admissions for the doctors' patients, computer links with the hospital, or placing a medical records branch office at the group practice.

Group Practice↗