Is there a role for primary care in the specialist's office?

Abstract

More opportunities exist to evaluate theories on cost savings in health care delivery as increasing numbers of Americans enroll in managed health care plans. Arizona has jumped into second place (behind Minnesota) as the state with the most patients per capita enrolled in managed care plans. Our private practice of otolaryngology is conducted in a physician-directed, multispecialty group in Phoenix, Ariz. Our group has contracts with 37 of the more than 50 managed care plans in place including the capitated Arizona Health Care Cost Containment System, which is the state's prepaid alternative to Medicaid. Several of these managed care plans have placed restrictions on referrals to specialists through "gate-keepers." The primary care providers acting as gatekeepers are motivated, to some degree, by economic incentives. The cost of referrals can be subtracted from the primary care provider's monthly capitated payment or can be deducted from the referral risk pool that is