Organizational and financial characteristics of health plans - Are they related to primary care performance?

Background: Primary care performance has been shown to differ under differe nt models of health care delivery, even among various models of managed car e. Pervasive changes in our nation's health care delivery systems, includin g the emergence of new forms of managed care, compel more current data. Objective: To compare the primary care received by patients in each of 5 mo dels of managed care (managed indemnity, point of service, network-model he alth maintenance organization [HMO], group-model HMO, and staff-model HMO) and identify specific characteristics of health plans associated with perfo rmance differences. Methods: Cross-sectional observational study of Massachusetts adults who re ported having a regular personal physician and for whom plan-type was known (n = 6018). Participants completed a validated questionnaire measuring 7 d efining characteristics of primary care. Senior health plan executives prov ided information about financial and nonfinancial features of the plan's co ntractual arrangements with physicians. Results: The managed indemnity system performed most favorably, with the hi ghest adjusted mean scores for 8 of 10 measures (P<.05). Point of service a nd network model HMO performance equaled the indemnity system on many measu res. Staff-model HMOs performed least favorably, with adjusted mean scores that were lowest or statistically equivalent to the lowest score on all 10 scales. Among network-model HMOs, several features of the plan's contractua l arrangement with physicians (ie, capitated physician payment, extensive u se of clinical practice guidelines, financial incentives concerning patient satisfaction) were signficantly associated with performance (P<.05). Conclusions: With US employers and purchasers having largely rejected tradi tional indemnity insurance as unaffordable, the results suggest that the cu rrent momentum toward open-model managed care plans is consistent with goal s for high-quality primary care, but that the effects of specific financial and nonfinancial incentives used by plans must continue to be examined.