Physician Organization in Relation to Quality and Efficiency of Care: A Synthesis of Recent Literature

Summarizes research linking cohesion, scale, and affiliation in physician groups to improved quality and efficiency. Discusses implications for promoting delivery system reform through physician group organization and changes to the payment system

How Can Medicare Lead Delivery System Reform?

Explores options and design issues for reforming the fee-for-service payment system to encourage better, more efficient health care through greater accountability for specific populations and totality of care. Proposes a Medicare demonstration program

Delivery System Reform Tracking: A Framework for Understanding Change

Proposes a framework for tracking progress on delivery system reforms such as patient-centered medical homes and accountable care organizations by assessing structures, capabilities, incentives, and outcomes. Outlines challenges for data collection

As Commercial Capitation Sinks, Can California's Physician Organizations Stay Afloat?

California is seeing the decline of capitation -- fixed prepayment for care of a defined population -- particularly for commercial health insurance products. This issue brief explores the impact of this trend on the state's medical groups and independent practice associations (IPAs). The main question at hand is whether California's delegated model will remain sustainable with lower levels of commercial capitation.The analysis is based on both quantitative and qualitative data. The medical group and IPA leaders interviewed for this research made a number of observations, including:The near future is uncertain. Declining capitation has not yet had a big impact on their operations, but they suspect it may soon.Change thus far has been slow enough that organizations have been able to adapt.Declining prepayment will not impact clinical decisionmaking.Medicare and Medi-Cal offer more opportunities to accept capitation, but these do not necessarily compensate for the loss of commercial capitation.Leaders are concerned that high deductibles may adversely affect the health of patients.The research points to the importance of continuing to track changes in the payment environment of California's capitated, delegated physician organizations. Although the decline in commercial capitation has been slow enough that it has not yet led to significant changes in operations, it may soon do so