Ateev Mehrotra, MD, MPH; Arnold M. Epstein, MD, MA; Meredith B. Rosenthal, PhD
Acknowledgments: The authors thank Sam Ho and colleagues at PacifiCare and the leaders of the physician organizations in their network for their cooperation and assistance. They also thank Alan Zaslavsky for statistical advice.
Grant Support: Data collection for this study was supported by the California HealthCare Foundation and the Commonwealth Fund. Dr. Mehrotra was supported by an institutional National Research Service Award (5 T32 HP11001-15).
Potential Financial Conflicts of Interest: None disclosed.
Requests for Single Reprints: Ateev Mehrotra, MD, MPH, RAND Health and University of Pittsburgh School of Medicine, 4570 Fifth Avenue, Suite 600, Pittsburgh, PA 15213-2665; e-mail, firstname.lastname@example.org.
Current Author Addresses: Dr. Mehrotra: RAND Health and University of Pittsburgh School of Medicine, 4570 Fifth Avenue, Suite 600, Pittsburgh, PA 15213-2665.
Dr. Epstein: Harvard School of Public Health, Kresge Building, Room 403, 677 Huntington Avenue, Boston, MA 02115.
Dr. Rosenthal: Harvard School of Public Health, Kresge Building, Room 405, 677 Huntington Avenue, Boston, MA 02115.
Mehrotra A, Epstein AM, Rosenthal MB. Do Integrated Medical Groups Provide Higher-Quality Medical Care than Individual Practice Associations?. Ann Intern Med. 2006;145:826-833. doi: 10.7326/0003-4819-145-11-200612050-00007
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Published: Ann Intern Med. 2006;145(11):826-833.
Despite the considerable investments made in measuring and monitoring quality of care at the health plan level, many have argued that physician groups are a more appropriate locus of quality measurement (1-2). Because physician groups are composed of the actual providers of care, they are better situated to improve the quality of care for their patients. Little is known, however, about the physician group characteristics that are associated with high-quality care.
One important characteristic of physician groups is their organizational structure. Integrated medical groups (IMGs) anchor 1 end of the spectrum of organizational structure. Such groups are centralized organizations in which physicians are employees or participants in a partnership arrangement. In general, physicians belong to only 1 IMG and practice together in facilities owned and managed by the group. At the other end of the organizational spectrum are independent practice associations (IPAs), which are decentralized groups (sometimes called “virtual” groups). Physicians typically have nonexclusive contractual relationships with IPAs and generally manage their own offices independently. In the middle of the spectrum are what we term “hybrids,” physician groups that are composed of a core medical group with an associated IPA.
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