A Health Maintenance Organization
Participating physicians are usually paid on a capitated or modified fee-for-service basis. An IPA can exert influence on behalf of its members to counterbalance the leverage of health care insurers. An IPA organizes the delivery of care, negotiates contracts with insurance companies; credentials and inspects member physicians, establishes primary care provider and specialist responsibilities; and disburses payment to physicians.

2. According to an essay published online by the United States Department of Health and Human Services, one of the goals of managed care HMOs contracting with IPAs is to prevent the potential overuse of health care specialists. Traditional HMOs permit access to specialists only with authorization from a primary care provider acting as a gatekeeper. According to a recent study, individuals who have direct access to specialists in their HMOs do not make more visits to specialists than individuals enrolled in gatekeeper HMOs. According to this essay, the rules governing the gatekeeper's role in an HMO may actually encourage additional visits to the primary care physician and to specialists. The rationale is simple: the more visits one has to a primary care physician, the more opportunities one has to get a referral to a specialist. Thus, the Managed Care IPA model may actually strain rather than reduce the strain on bo

 
 
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