Beyond the Gatekeeper: How Managed Care Organizations Affect the Use of Technology
How do managed care organizations control use of technology and specialists to produce savings? This study examined the tools managed care organizations use to influence the use of specialists and technology and whether those tools may help produce long-term savings. Researchers studied management rules in a system that might govern use of technology such as gatekeepers or protocols; physician profiling or feedback to physicians based on what they prescribe, to see how they compare with other physicians in the group; and financial incentives that discourage utilization patterns that lead to higher costs. The objective of the project was to offer a better understanding of how effective managed care is likely to be in controlling health care costs, its impact on access to specialists and expensive technologies, and its effect on quality.