ORGANIZING AND OPERATING A PREFERRED
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 related to the managed care concept it self.
With respect to the organization of a managed care network, three major areas of interest are reviewed. These interest areas are licensure, health care service distribution channels, and the negotiation of participation agreements. These three areas are not the only ones that must be dealt with in the organization of a PSN, but they are the areas that hold the greatest potential for the making of critical mistakes. The importance of these three interest areas justifies th...