IPA OVERVIEW – The Key to Accountable Care (ACO’s)

Private practice physicians who form an association to meet the challenges of managed care or direct contracting with employers position themselves and their IPA to take advantage of many opportunities. For example, the most popular form of HMO network is the IPA model. In addition many states allow IPAs to assume risk without forming a group practice. Still other IPAs have opted to become members of physician hospital organizations finding both strength and success acting as a unified provider body.  Many believe that the IPA will function as a key component of an ACO (accountable care organization), if structured properly.

The IPA serves as a vehicle for private practice physicians to get together. It allows the physicians to address issues together without losing their independence. Perhaps this underlying fibre of an IPA is both the potential strength and weakness of this approach. Successful IPAs have found balance in regard to this issue.

The underlying success of an IPA model and resulting value of the contracts and services which the IPA delivers to its constituent physicians is based on the commitment of the physicians to support their IPA’s philosophy, objectives and leadership’s decisions. In addition, the complexity and constantly changing market requires for success that an IPA remain flexible and willing to collaborate with other strategic providers and payers.

THE IPA CONCEPT

The core component of an IPA is its ability to represent its members as a negotiating and contracting vehicle with payer organizations in a managed care environment. In turn, this portends that the IPA will offer administrative and medical management services. As the purpose of the IPA is to grow access to lives, it is important to develop those services which will help assure success as opportunities become available. It must provide a proven, competent network of providers, affect medical management, claims processing, utilization/case/disease state management and potentially, marketing and sales for direct contracting purposes.

THE IPA APPROACH

A successful approach to building an IPA is to take those steps necessary to include physician leaders in governance. These leaders in turn must be willing and able to represent and communicate with their fellow members.

The key to the initiative is the continued accommodation of physician autonomy while responding to the ever changing market forces. The IPA must provide education and leadership to the constituents so that they are willingly led to a position of strength for their own and the IPAs long term interests.

The physician leaders of the IPA can utilize a steering committee approach to affect governance and leadership. In this method, physicians become involved in an advisory policymaking capacity, prioritizing efforts and selecting those options and approaches which will have both appeal and payback while minimizing political problems. Other committees, e.g., bylaws, membership/credentialing, utilization/quality management, and finance/information services committees allow physicians to understand and help control the managed care process while acting in unison to achieve IPA objectives.

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