They are making plenty of money and have no interest in transferring some of that premium to another organization. To date, he can report success with only one plan. Other plans Dr. Tooke talked to were not interested, he said, because they do not understand why giving global capitation to a physician organization is not the same as helping the competition. On the other hand, John Seitz, a consultant with Cornerstone Physicians Corp. in Irvine, Calif., said his experience has been that HMOs, including some very large ones, are generally willing to give global caps to groups. The problem, he said, is that doctors who are not ready for global capitation are asking for it anyway.
Preparation can make a difference.
But first it had to invest tens of thousands of dollars in information systems, in hiring consultants with managed care expertise and in living with low primary care caps. But more recently employers there, who have joined together in a strong health insurance purchasing coalition, have begun talking about cutting the HMOs out and contracting directly with provider groups, largely on a non-capitated basis. They say, 'If utilization is low, good. We'll give you our business. It is primarily in communities like Los Angeles, San Diego and San Francisco that provider groups have become large enough and powerful enough to get the global caps they demand.