Competing HMOs collaborate to improve preventive services

Patients' trust in their physicians: effects of choice, continuity, and payment method

OBJECTIVE

To evaluate the extent to which physician choice, length of patient-physician relationship, and perceived physician payment method predict patients' trust in their physician.

DESIGN

Survey of patients of physicians in Atlanta, Georgia.

PATIENTS

Subjects were 292 patients aged 18 years and older.

MEASUREMENTS AND MAIN RESULTS

Scale of patients' trust in their physician was the main outcome measure. Most patients completely trusted their physicians "to put their needs above all other considerations" (69%). Patients who reported having enough choice of physician (p < .05), a longer relationship with the physician (p < .001), and who trusted their managed care organization (p < .001) were more likely to trust their physician. Approximately two thirds of all respondents did not know the method by which their physician was paid. The majority of patients believed paying a physician each time a test is done rather than a fixed monthly amount would not affect their care (72.4%). However, 40.5% of all respondents believed paying a physician more for ordering fewer than the average number of tests would make their care worse. Of these patients, 53.3% would accept higher copayments to obtain necessary medical tests.

CONCLUSIONS

Patients' trust in their physician is related to having a choice of physicians, having a longer relationship with their physician, and trusting their managed care organization. Most patients are unaware of their physician's payment method, but many are concerned about payment methods that might discourage medical use.

Developing an AHC-MCO alliance for research and care

Academic health centers (AHCs) and managed care organizations (MCOs) appear to be on a collision course. Is it possible to develop a partnership to enable both parties to achieve their respective goals and objectives? The Kimmel Cancer Center of Thomas Jefferson University and AEtna US Healthcare, one of the nation's largest MCOs, have developed an alliance designed to generate cancer prevention and control research. This arrangement engages the participants in a collaborative effort that is aimed at creating new knowledge that can be used to enhance the provision of health care to a defined population.

Partnerships for research among managed care organizations

Researchers within health maintenance organizations (HMOs) need to create greater opportunities for collaborative research within their organizations. Multisite research will yield high-quality information for improving care. This paper describes situations in which competition as well as collaboration are possible across HMOs in the current environment. The paper considers the following questions: (1) What criteria determine if a project can be conducted as a multisite study; and (2) what population and organizational features should be considered when designing cross-site collaboration? The paper also discusses two important trends in the larger health care environment: cost containment, which is both a challenge and an opportunity for health services researchers working within managed care; and mergers and acquisitions, which are changing the face of the larger health care industry.

Prevention and control research within a changing health care system

The agenda for behavioral and social science research in cancer prevention and control needs to be assessed and interpreted within the context of a changing health care system. These changes present potential opportunities and barriers to an evolving research agenda. Opportunities include access to defined populations and providers, emphasis on clinical outcomes, and access to clinical and financial data. Barriers include intense competition among providers and an overriding emphasis on cost containment. To meet these challenges, attention needs to be given to developing new partnerships with provider organizations, emphasizing interdisciplinary cooperation and training, and reassessing underlying behavioral assumptions and models.

The multilevel compliance challenge: recommendations for a call to action. A statement for healthcare professionals

Despite the universally accepted importance of compliance, strategies known for more than two decades to be effective are not routinely incorporated into clinical practice. For the benefits of primary and secondary prevention to be realized in diverse population groups and settings, emphasis must be placed on implementing strategies at the patient, provider, and organization levels. Current knowledge of compliance strategies, if integrated into a multilevel approach, offers enormous promise for decreasing risk and improving patient outcomes.