Toward a 21st Century Health System

Toward a 21st Century Health System is a collection of thoughtful analyses that explore a key element of the health care delivery system-physician group practices. Edited by policy experts Alain Enthoven and Laura Tollen, and written by a blue ribbon panel of health policy scholars and leaders including Stephen Shortell, Hal Luft, Donald Berwick, James Robinson, and Helen Darling, this resource addresses a variety of topics, including Organized delivery systems Quality of care in prepaid group practice versus other types of managed care The role of physician leadership and culture in group practice Prepaid group practice and the formation of national health policy This comprehensive resource also covers such topics as pharmacy benefit management, technology assessment, health services research, and employer purchasing of benefits– all as they relate to prepaid group practice.

Tables and Exhibits ix Acknowledgments xi The Contributors xiii Foreword xxiii William L. Roper Preface xxvii Alain C. Enthoven, Laura A. Tollen 1 Prepaid Groups and Organized Delivery Systems: Promise, Performance, and Potential 1 Stephen M. Shortell and Julie Schmittdiel 2 Systems and Results: The Basis for Quality Care in Prepaid Group Practice 22 Donald M. Berwick and Sachin H. Jain 3 The Clinical and Economic Performance of Prepaid Group Practice 45 Kenneth H. Chuang, Harold S. Luft, and R. Adams Dudley 4 Prepaid Group Practice and Health Care Policy 61 Jon B. Christianson and George Avery 5 Technology Assessment, Deployment, and Implementation in Prepaid Group Practice 85 David M. Eddy 6 Managing the Pharmacy Benefit in Prepaid Group Practice 108 William H. Campbell, Richard E. Johnson, and Sharon L. Levine 7 Prepaid Group Practice and Medical Workforce Policy 128 Jonathan P. Weiner 8 Prepaid Group Practice and Health Care Research 156 Raymond Fink and Merwyn R. Greenlick 9 Physician Leadership: “Group Responsibility” as Key to Accountability in Medicine 179 Francis J. Crosson, Allan J. Weiland, and Robert A. Berenson 10 The Limits of Prepaid Group Practice 199 James C. Robinson 11 The Relationship Between Prepaid Group Practice and the Employer Community 213 Helen Darling 12 Open the Markets and Level the Playing Field 227 Alain C. Enthoven Editors’ Introduction to the Epilogue 247 Epilogue: Prepaid Group Practice and Computerized Caregiver Support Tools 249 George C. Halvorson Appendix: The Origins of Prepaid Group Practice in the United States 265 Jon A. Stewart Index 275