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Tables of Contents for Ipa Management
Chapter/Section Title
Page #
Page Count
Preface
v
Initial Planning
1
12
What Is an IPA?
1
1
Why Do IPAs Form?
2
1
Three Theories of Approach
3
1
No Guarantee of Success
4
1
Operation Start-Up
4
2
Identify the Planning Team
4
1
Assess the Marketplace
5
1
Evaluate Your Own Attributes
5
1
Develop a Business Plan
6
1
Structure the Legal Entity
6
1
Organization
6
1
Developing a Provider Contract and Compensation Model
6
1
Recruiting Panel Members
7
1
Developing a Market Strategy
7
1
Forming the Management Structure
7
1
Employing the Experience of Others
7
5
Requests for Proposals
9
3
Summary
12
1
Characteristics of an IPA
13
10
IPA Models
15
1
Messenger Model IPA
15
1
Risk Sharing Model
15
1
Combination Messenger / Risk Sharing Model
15
1
Operational Variations
15
1
Advantages and Disadvantages
16
1
Customers of the IPA
17
1
Terms and Definitions
18
3
Summary
21
2
Mission and Goals
23
6
Performing an Internal Assessment
23
2
Defining Members' Goals
25
2
Primary Goals
26
1
Other Goals and Objectives
26
1
Summary
27
2
Cultural and Clinical Compatibility
29
8
Characteristics of Culture
29
1
Negative Origins
30
1
Defining the IPA's Culture by its Membership
31
4
Cultural Refinement strategies in a Diverse Group
32
3
Summary
35
2
Defining the Functions of an IPA
37
10
Basic Functions
37
1
Marketing to Obtain Contracts with MCOs
38
1
Obtaining Insurance Contracts
38
1
Obtaining Other Provider Contracts
39
1
Developing an IPA Fee Schedule
40
1
Obtaining Capital
40
1
Establishing Internal Systems
40
1
Defending the Marketplace Position
40
2
Against Competition
41
1
Against Deselection
41
1
Against Third Parties
41
1
Other IPA Functions
42
2
Formation of a Management Services Organization
43
1
Other Integration Arrangements
43
1
Medical Practice Management
44
1
Summary
44
3
Competencies
47
10
Data Capture
48
1
Contracting Competency
48
3
Vocabulary of Risk
49
1
What Risk Is Being Assumed?
50
1
Leveraging the IPA
51
4
Initial Negotiation or Renegotiation of Existing Contracts
54
1
Administration
55
1
Utilization Management
55
1
Network Development
55
1
Practice Management
56
1
Stop-Loss Reinsurance
56
1
Summary
56
1
Capital Requirements for Start-Up
57
10
Capital Needs
57
1
Risk Sharing Model
58
1
Messenger Model
58
1
Developing a Business Plan
58
2
Capital Sources
60
4
Presenting Your IPA's Business Plan to Secure Capital
64
2
Summary
66
1
Ownership and Governance
67
8
Selecting a Business Structure
68
1
S Corporations
68
1
Limited Liability Companies
68
1
Ownership
69
1
Goverance
69
1
Physician Leadership
70
3
IPA Leadership Skill-Set
70
1
Physician Participation
71
2
Physician Executive Committee
73
1
Legal Issues Concerning IPAs
73
1
State Laws
73
1
Antitrust Issues
74
1
Summary
74
1
Committee Development and Structure
75
6
Committee Structure
75
4
Executive Committee
76
1
Contracting Committee
76
1
Credentialing/Membership Committee
77
1
Quality Assurance/Utilization Management
77
1
Expense Management Committee
77
1
Practice Managers Committee
78
1
Optional Committees
78
1
Summary
79
2
Selecting the Management Company
81
6
Goverance and Management
81
1
Administrative Personnel
82
4
Administration
83
1
Financial Administration
84
1
Quality Assurance / Utilization Management
85
1
Provider Relations
85
1
Summary
86
1
Developing Reimbursement Models
87
14
Developing a Minimum IPA Fee Schedule
87
3
Developing an Acceptable Capitation Rate
90
1
Payment Mechanisms
90
9
Full Fee Schedule for All Physicians
91
1
Capitate PCPs with Specialists at Fee-for-Service
92
1
Primary Care at Fee-for-Service and Capitate Specialists
93
1
PCPs at Fee-for-Service and Specialists from Specialty Pools
94
1
Capitate PCPs and Pay Specialists from Specialty Pools
95
1
Capitate Both PCPs and Specialists
96
1
Capitate PCPs for Comprehensive Professional Services (Full Personal Capitation)
97
1
True Capitation for Specialists
98
1
Summary
99
2
Developing a Marketing Strategy
101
6
Creating a Marketable Product
101
1
Single or Multispecialty Focus?
102
1
Developing a Marketable Network Through Panel Selection
103
1
Preparing a Marketing Process
104
1
Obtaining the Contract
104
1
Provider-Payor Partnering
105
1
Continual Marketing Follow-Up
105
1
Summary
106
1
Recruiting Panel Members
107
4
Selecting the Network Provider Panel
107
3
Provider Ratios
108
1
Cost-efficiency
108
1
Quality-Assurance
109
1
Geographic Coverage
109
1
Antitrust Issues
109
1
Summary
110
1
Setting Up to Succeed
111
2
Market Determines IPA's Success
112
1
Summary
112
1
Resources
113
2
About The Authors
115
2
Index
117