Creation and Operation of a PPO

Introduction to the Summary of the Paper

This paper reviewed 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).

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.(

Summary of the Introduction to the Paper

The (Introduction( to the paper reviewed briefly the changes in the health care environment in the United States that caused 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 was the managed care concept, which is the basis for this paper. The (Introduction( also covered some of the disputes related to the managed care concept it self.

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ompanies. In another example, a PSN could affiliate with a major hospital system so that the PSN(s patients would be referred to the organization by the hospital. These issues are examined in the (Health Care Distribution Channels( sub-section in the paper. Negotiating Participation Agreements Summary A participation agreement is a contract between two organizations involved in the delivery of health care services. Such a contract spells out the rights, responsibilities, and procedures that govern the actions of the two organizations in the delivery of health care to patients. In the (Negotiating Participation Agreements( sub-section of the paper, the important factors that must be dealt with in contracts are discussed. An emphasis 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
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Approximate Word count = 2125
Approximate Pages = 9 (250 words per page)

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