Rethinking specialist integration strategies

To surmount the economic pressures of managed care, specialists are pursuing various initiatives designed to increase revenues and market share that may put them into competition with healthcare systems. Systems contemplating collaboration with specialists to gain their loyalty may first consider employing a strategy involving physician gain sharing. It should be understood, however, that there are legal hurdles to be overcome in developing gain sharing, that there are different gain-sharing models to be used, and that there are limitations as well as benefits to such an initiative. These limitations require healthcare systems to consider other, more durable specialist integration strategies. The balance of power between a healthcare system and specialists will affect the success of whatever integration strategy is employed.

A Stereospecific Synthesis of Ring A-aromatic Steroids

A diene synthesis using 2,6-xyloquinone as dienophile and boron trifluoride as catalyst does not follow the normal orientation rules and leads to a facile synthesis of ring A-aromatic steroids. A tetracyclic adduct prepared by a similar reaction and containing the steroidal C19-methyl group is also reported.