Oxford’s new care model catches attention
Oxford’s new care model catches attention
Program focuses on specialties
Norwalk, CT-based Oxford Health Plans is lauding its specialty care model as the managed care model of the future, and industry experts like the Washington, DC-based Advisory Board Company agree.
Although some consultants remain concerned about the company’s financial viability given recent earnings drops (Oxford reported a $78 million loss for third quarter 1997), most point out that these problems are not related to the specialty management model and shouldn’t affect the model’s chances of success.
"It’s an excellent program that has nothing to do with their earnings issues," says Clifford A. Hewitt, health care analyst for New York City-based Sanford Bernstein & Co. "In fact, this is the solution to some of their earnings issues. In their market [the Northeast], medical groups aren’t really set up to properly manage care, except for MedPartners’ ownership of Summit Medical Groups. They are reluctant right now . . . to enter into some percentage-of-premium contracts with medical groups. To them, that just takes away what they consider a part of their business. It’s a form of budgeted capitation, saying here’s what your costs should be, we have the data. You guys agree on how you want to treat it.’"
The premise of the specialty-team concept: Provider teams selected through a request-for-proposal (RFP) process enjoy delegated medical decision making, utilization review, and many other functions that usually require managed care health plan approval, based on approval of a treatment plan outlined during the RFP.
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