Introducing the Preferred Provider Organization Option into Health Benefit Plans

Three Case Studies

by Elizabeth S. Rolph

Download

Download eBook for Free

FormatFile SizeNotes
PDF file 7.3 MB

Use Adobe Acrobat Reader version 10 or higher for the best experience.

Purchase

Purchase Print Copy

 FormatList Price Price
Add to Cart Paperback176 pages $40.00 $32.00 20% Web Discount

This Note describes preferred provider organization (PPO) arrangements of employers in three different locales. For each of these case studies, the Note describes the context in which the PPO arrangement was constituted and first marketed, including the existing health care marketplace, the program objectives of the various PPO participants, and their initial negotiating efforts. It also examines the features tailored to attract the participating subscribers, payers, and providers, giving specific attention to the channeling incentives offered to attract subscribers and guarantee volume to providers. It also examines the discounting practices adopted to meet the cost-containment objectives of the payers. Finally, it explores the utilization review procedures — a second cost-containment device — for each case study. The findings suggest that the original PPO concept's distinct outlines are now blurring, and that it may still be too early to describe the PPO's ultimate shape and function.

This report is part of the RAND Corporation note series. The note was a product of the RAND Corporation from 1979 to 1993 that reported other outputs of sponsored research for general distribution.

Permission is given to duplicate this electronic document for personal use only, as long as it is unaltered and complete. Copies may not be duplicated for commercial purposes. Unauthorized posting of RAND PDFs to a non-RAND Web site is prohibited. RAND PDFs are protected under copyright law. For information on reprint and linking permissions, please visit the RAND Permissions page.

The RAND Corporation is a nonprofit institution that helps improve policy and decisionmaking through research and analysis. RAND's publications do not necessarily reflect the opinions of its research clients and sponsors.