Mysteries of the IPA
Updated: Feb 19, 2018
The Independent Physician Association (IPA) has become a staple in the western states, and most notably California. According to Grumbach, Coffman, Vranizan, Blick and O'Neil (1998) one third of the primary care physicians are involved with at least one IPA. It seems that many physicians agree that contracting with an IPA is advantageous for the practice. However, there seems to be confusion over who they are and how to navigate the system.
The IPA is a multi-specialty organization of individual physicians and small practices. The HMO carrier contracts directly with the IPA, as opposed to contracting with individual providers. The IPA system is different from more common two-tier system where the insurance payers deal directly with the individual provider. The IPA adds a third tier where the IPA acts as an intermediary between the carrier and the individual provider. The carrier pays the IPA a capitation payment that would be distributed among its healthcare providers based on those individual contracts. The carriers favors this because it passes the liability to the IPA, and reduces the cost of healthcare. Through this relationship the individual provider has the potential to reach a bigger patient base. The IPA is then able to compete with large HMO groups such as Kaiser Permanente (Asner, 2003).
The IPA is usually contracted by the insurance carrier to manage the HMO benefits. This includes authorization and claim management. The confusion arises when the patient needs to speak to someoneregarding a specific problem. The assumption by most is to go contact to their HMO insurance carrier, however it may be the IPA because its authorization and claim management functions. However, many times the patient might have to yo-yo between the IPA and the HMO. It quickly becomes a frustrating situation with no light at the end of the tunnel. Acquiring the assistance of a patient advocate, such as Compass Copay, may help facilitate the necessary dialog to successfully navigate the system.
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Asner, B. (2003). The California independent Practice Association "IPA" Model. California Association of Physician Groups.
Grumback, K, Coffman, J., Vranizan, K., Blick, N., and O'Neil, E.H. (1998). Independent practice association physician groups in California. Health Affairs, 17, no. 3: 227-237