BEHIND THE CURVE - A CRITICAL-ASSESSMENT OF HOW LITTLE IS KNOWN ABOUTARRANGEMENTS BETWEEN MANAGED CARE PLANS AND PHYSICIANS

Extraordinary growth in managed care arrangements over the past decade has been both widely praised and criticized. Proponents and critics a gree that the nature of medical practice is being profoundly altered b y this growth, even if they cannot articulate the direction and conseq uences of this change. We explore the roots of this uncertainty by exa mining the available evidence on critical features of the arrangements managed care plans currently have with affiliated physicians. Our app roach is to review and synthesize the literature in several key substa ntive areas from a broad range of sources. We found that existing know ledge is dated, derived from a limited subset of plans, inattentive to important structural differences between plans, and responsive to a v ery narrow set of issues poorly reflecting the range of medical practi ce and change introduced by managed care We highlight key questions of interest and the knowledge gaps critical to address so that policy an d management decisions can both reflect and be informed on these issue s that define the arrangements managed care plans make with physicians and ultimately influence medical practice.