Managed Care Network

Introduction to the Summary of the Paper

This paper reviews the major issues that must be dealt with in the creation and operation of a managed care network. The type of managed care network considered in this paper was a preferred provider organization (PPO). The specific type of PPO examined in this paper was a physician-sponsored network (PSN), which is a network of physicians who join together to provide managed care. This paper was structured into two major sections in addition to the (Introduction( and (Conclusion.( The first major section in the paper examined the major issues that are involved in the organization of a PSN. The second major section reviewed the major issues that must be faced in the operation of a PSN once the managed care network has been established.

The rest of this summary covers each of the four sections of the paper. These sections are the (Introduction,( (Organizational Concerns,( (Operational Concerns,( and the (Summary and Conclusion.(

The (Introduction( to the paper reviews briefly the changes in the health care environment in the United States that cause government, health insurance companies, employers, and others to begin looking for ways to reduce the growth in health care costs. One outcome of this search is the managed care concept, which is the basis for this paper. The (Introduction( also covers some of the disputes

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mphasis in this discussion is placed on the types of decisions that must be made by the founders of a PSN when negotiating participation agreements with other managed care organizations. The factor that must be considered in making these decisions also are considered in the paper. Summary of the Operational Concerns Section of the Paper With respect to the operation of a managed care network after such a network has been established, five major areas of interest were reviewed. These interest areas were developing competitive advantage, case management, purchaser-oriented management, information management, and performance analysis. These five areas are not the only ones that must be dealt with in the operation of a PSN, but they are the areas that hold the greatest number of potential pitfalls for a PSN. The potential for the development serious problems involving these five interest areas justifies their emphasis in this paper. The reviews of each of these interest areas are summarized in the following discussions. Developing Competitive Advantage Summary A competitive advantage exists when some person or some organization can do something better or more efficiently than can some other person or organization. For a
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Approximate Word count = 3217
Approximate Pages = 13 (250 words per page)

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