What Works, What Doesn’t: From IPAs to Risk Sharing

John A. Marcille

The philosopher G.K. Chesterton, writing at the turn of the century (last century, not this one) said, “The whole difference between construction and creation is exactly this: A thing constructed can only be loved after it is constructed; but a thing created is loved before it exists.”

Our cover story on IPAs seems to be about a system created by those who wanted to restore the healing touch that many perceived as having been siphoned off by managed care. Some would say that IPAs, more than HMOs, appear to be about love of medicine more than hatred of rising costs.

As author and contributing editor Karen L. Trespacz points out, the two systems need not be antagonistic. In fact, IPAs can help HMOs in so many ways: from jump-starting new plans, to improving compliance with health programs, to promoting better medical management.

Clichés are harmful not because they are wrong; they're harmful because they encourage lazy thinking. So think before you agree that all health care is indeed local. Then further accept that IPAs may be the best system for managing care locally.

It comes down to what works, what doesn't. No surprise there. That's always how it is in this magazine and this issue is no different. Read about how auto maker DaimlerChrysler applied this process in streamlining care for its employees and the health plans that serve them. Take a look at the problems — lack of historical data, ambiguous language — that can turn a risk-sharing contract sour. Our Q&A is with the head of the People's Medical Society — Charles B. Inlander — who doesn't pull punches discussing what he thinks makes sense.

Finally, there's a story about how physicians often attack colleagues in the press, tarnishing the public's view of the profession. Chesterton fielded this one as well: “The artistic temperament is a disease that afflicts amateurs.”