and knowledge are important elements of any relationship. When it
comes to health decisions, patients and physicians must actively
The Tri-State Independent
Physicians Association, Inc. would like to help you make informed
decisions about your healthcare. We believe it's important for consumers
to understand as much as possible about today's complex healthcare
environment and the role the IPA and its participating physicians
What is managed care?
Originally the term "managed care" referred collectively
to prepaid health plans. Today employers and consumers face a wide
array of choices when it comes to purchasing healthcare services.
The emergence of managed care has created a virtual alphabet soup
for consumers to deal with. The terms "health maintenance organization"
(HMO) and "preferred provider organization" (PPO) have
become part of our vocabulary, but managed care plans actually come
in a variety of different flavors today.
Managed care plans range
in type from "more restrictive" to "less restrictive"
models. The lines between types of managed care plans are becoming
blurred. A common thread among all managed care plans, however,
is that they seek to combine the financing and delivery of health
What is an IPA?
IPA stands for "independent physicians association". Independent
physician means physicians in private practice, in contrast to physicians
who are employees of a corporation, such as a hospital or HMO. Physicians
join IPAs to gain the advantage of group purchasing, recruitment,
managed care contracting, shared information systems, etc.
Because IPA physicians
are in private practice, they are able to see private patients as
well as patients who are covered by the managed care plans that
an IPA contracts with. This is good for consumers for several reasons.
One, it helps to keep healthcare more affordable, by allowing health
plans to take advantage of resources that are already available
in the community.
Another advantage to
consumers is that, since IPA physicians are in private practice,
they can see other members of your family even if they aren't covered
by your health plan. On the other hand, if you're required to see
a physician who works exclusively for an HMO, the rest of your family
may have to go to a different physician.
Finally, with a large
IPA, it's likely that you'll be able to enroll in an IPA-based health
plan and still be able to continue seeing the same family physician
you've had all along.
What is credentialing and why is it important?
At its most basic, credentialing means the process of checking a
physician's background and qualifications. At Tri-State IPA
it means much more.
When a physician applies
for membership with Tri-State IPA, our credentialing staff
performs verification of the following:
- Education - when,
where, degrees, etc.
- Employment history
- Hospital privileges
- Certification in various
- Licenses to practice
- Liability insurance
- Disciplinary actions,
if any, including malpractice claims
- Peer references -
can other physicians who have worked closely with the applicant
attest to his or her competence?
Only after all the items
have been satisfactorily documented is a physician considered for
membership in Tri-State IPA. And every two years the items
that are subject to change are verified again, in order for a member
to remain in Tri-State IPA.
are based upon National Committee for Quality Assurance (NCQA)
criteria and reviewed periodically by the health plans we
work with to ensure that we're performing to the highest standards.
is this important to consumers? It simply means you can depend
on Tri-State IPA physicians to provide the finest medical
care in your community.