Organizing a PSN

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 dispute

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are altering the way physicians relate to hospitals. Hospitals thus must form much closer relationships with physician group practices and other managed care groups to assure that the hospitals will continue to receive high levels of referrals of patients of all specialties. The issue of motives is important because participants in health care affiliation negotiations often distrust the motives of the other party. Motives must be among the first issues discussed. The physician founders are often attracted to the managerial support and economies available through affiliation with hospitals. Many physicians need to associate with hospitals to share functions of billing, collecting, and contracting because they are not strong enough as independent physicians financially, politically, or managerially to deal with the different groups involved and the growing costs of health care. The founding group must make policy decisions about the scope and nature of the PSN and about issues relating to hospital involvement for the PSN. They must also make decisions about contracting, claims processing, and issues regarding capital expenditures for facilities and consolidation or expansion of the group. In the (Negotiating Participation
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Approximate Word count = 2670
Approximate Pages = 11 (250 words per page)

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