The puzzling popularity of the PPO.

Surging growth in preferred provider organization (PPO) participation has been fueled by migration away from the undesirable features of health maintenance organizations (HMOs). While employers, consumers, and providers seem to know what it is they do not want from HMOs, the advantages offered by PPO design are not so clear. This is attributable in part to difficulties in determining what a PPO arrangement actually is. But it may also reflect a lack of strong evidence that PPOs control costs, provide active care management, or promote quality improvement.

Fighting fire with fire: physicians blazing new paths to autonomy.

Thousands of physicians around the country have stopped complaining about being burned by the system and have started reengineering their destinies. They're building super IPAs, forming and operating HMOs, and joining unions to represent their rights in a growing grassroots physician effort to regain control. These physicians have thumbed their noses at managed care companies they say have drastically cut reimbursements, arbitrarily dropped them from panels, dictated utilization, and cost them patients. They're tired of working harder and earning less and frustrated by sacrificing quality in the name of cost reduction. And they have learned that there are ways to prevail.

Guidelines for physician contracting with alternative delivery systems.

The rapid proliferation of alternative healthcare delivery systems--particularly health maintenance organizations (HMOs) and preferred provider organizations (PPOs)--means that physicians contemplating participation in one of these entities must obtain, at the least, information about the group's ability to operate efficiently and effectively. For physicians who are contracting directly with a specific HMO, PPO, or independent practice association (IPA), issues that are relevant in all situations include termination, submission of data, discipline procedures, no solicitation covenants, arbitration clauses, rights to discontinue treatment, use of consultants, compliance with state and federal laws, and exclusivity.