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Robert E. Hurley, Bradley C. Strunk, and Justin S. White The Puzzling Popularity Of The PPO Health Affairs, March/April 2004; 23(2): 56-68. [Abstract] [Full Text] [Figures Only] [PDF] [Reprints & Permissions]

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And You Were Suprised By This?

Jonathan M. Fuchs   ( 22 March 2004 )

And You Were Suprised By This? 22 March 2004
Jonathan M. Fuchs Managed Care Consultant Send letter to journal: Re: And You Were Suprised By This? jmfstrat{at}aol.com Jonathan M. Fuchs	From the beginning, PPOs were designed as a means to provide an employer (customer) a volume discount from providers based upon a customer's employee component in a given geographic area. So it is no surprise that brokers and third-party administrators (TPAs) view PPOs as the baseline for obtaining discounts for medical care. To call PPOs "managed care" in the purest sense is a chimera. Provider negotiations were conducted contingent upon the redirection of a customer's employees coupled with, initially, a meager benefit differential (i.e. 10%) offered to an employee to use the PPO network. They were designed as an introduction to selective contracting, cost containment, and restrictive access. Now, there may be greater differentials, additional requirements (i.e. utilization management, data requirements, tiered network plans), but all in all things have not changed all that much. It is clear that information management, wellness, program evaluation, and quality assessment continue to be elusive in the PPO environment. Whether or not networks have become ubiquitous is a valid question. The value that a network provides to an employer in terms of coverage, access, price, and quality needs to be fully addressed and evaluated by the employer and the consumer, regardless of a PPO's network composition or differentiation. The inability of PPOs to deliver on this value equation after twenty years of market presence represents continued failure in health care policy and delivery.