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GAO-12-291R 1 (2012-03-16)

handle is hein.gao/gaobacfvo0001 and id is 1 raw text is: Accountabiliy - Integrity - Reliability United States Government Accountability Office Washington, DC 20548 March 16, 2012 Congressional Requesters Subject: Federal Antitrust Policy: Stakeholders' Perspectives Differed on the Adequacy of Guidance for Collaboration among Health Care Providers Health care delivery in the United States generally is fragmented, with care delivered by multiple providers and in multiple care settings, often without systematic coordination across providers and settings.1 This can lead to inefficient care delivery, poor quality of care, and patient dissatisfaction. There is a growing consensus among providers, researchers, and policymakers that collaboration among health care providers is essential to addressing these problems. Collaborative arrangements can take a variety of forms, including collaborations among independent physician groups-called physician arrangements-or among multiple types of independent providers-called multiprovider arrangements. For example, a physician arrangement could involve a network of primary care physicians and specialists, such as cardiologists and radiologists, who contract collectively with health plans. Similarly, a multiprovider arrangement could involve a hospital collaborating with groups of physicians to contract collectively with health plans. Collaborative arrangements may be able to address problems associated with fragmented care delivery because providers generally have greater resources and ability to coordinate care when collaborating with each other than when acting separately. For example, providers within a collaborative arrangement could pool resources to use electronic health records (EHR) to obtain timely and relevant clinical information and enable them to coordinate patient care across various care settings, potentially improving efficiency and quality of care. Or providers collaborating with each other could negotiate capitated rates with health plans to give these providers a financial incentive to furnish care efficiently.2 While collaborative arrangements can have potential benefits, such arrangements may lead to higher prices. In a competitive health care market, consumers are able to choose from a wide variety of competing providers that have an incentive to 1Some patients, particularly those with multiple conditions, may receive care from multiple primary and specialty providers across different settings, including physician offices and hospitals. 2A capitated rate is a fixed amount that health plans pay per patient that covers a specific bundle of services for a period of time, such as 1 month, regardless of the amount of these services a patient uses. Providers in collaborative arrangements that are paid at a capitated rate have a financial incentive to provide care efficiently because they keep the difference if a patient's actual cost of services is less than the capitated amount and lose money if the actual cost of care exceeds the capitated amount. GAO-1 2-291 R Provider Collaboration and Antitrust Policy

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