Managed care in the doctor's office: Has the revolution stalled?

Objective: To assess trends in the involvement of US physicians with manage d care. Study Design: Comparison of data from 2 consecutive rounds of a national su rvey. Method's: Longitudinal data were obtained from the 1996/1997 (n = 12,528) a nd the 1998/1999 (n = 12,304) rounds of the Community Tracking Study (CTS) Physician Survey, a large, ongoing nationally representative survey of US p hysicians involved in patient care. Indicators used to assess involvement w ith managed care included global measures of managed care participation, ri sk contracting, exposure to financial incentives, and impact of care manage ment tools. Changes in these measures over the 2 study periods are reported . Analyses were conducted for all physicians, as well as for primary care p hysicians (PCPs) and specialists separately. Results: The percentage of practice revenue derived from managed care incre ased only modestly over the study period (from 42% to 45%). Mean numbers of managed care contracts per physician increased minimally (from 12 to 13). Trends in acceptance of capitation and exposure to financial incentives rem ained stable over the study period. Among PCPs, employment in staff/group h ealth maintenance organizations declined slightly, whereas gatekeeping func tion increased, modestly. Among care management tools, only treatment guide lines had a significantly increased impact on medical practice, primarily a mong PCPs (from 46% to 52%; P < .001). Conclusions: Many aspects of managed care leveled off between 1996 and 1999 in ways not accurately reflected by plan enrollment patterns. This "flatte ning of the curve" trend appears to hold generally across multiple measures . A stalling of the managed care "revolution," if it is sustained, may port end future escalation in healthcare costs.