- Assume responsibility for coordinating a broad continuum of care designed to improve or maintain the health of a large number of patients;
- Be paid a flat rate for each person in its care, as opposed to billing for each procedure or treatment, and;
- Reduce emergency-room visits and return hospitalizations by closely coordinating care and stressing prevention and chronic-disease management.
The industry is challenged in many ways, including the difficulty of knowing who our customers are and how much influence any particular constituency actually exerts. We might be ahead of the game, though, if we remember how HMOs shaped care at their inception but add the impact of electronic medical records, greater reliance on evidence-based medicine, a growing primary care physician shortage, yet older patients and more expensive medical technology than ever.
Debbie Kossman, PhD, is SVP, National Analysts Worldwide, and 2011 chair of the board of the PMRG