Oxford Health Plans: Specialty Management (A)

Describes an innovative approach to organizing health care proposed by Oxford CEO Steve Wiggins. Wiggins contends that the primary care physician "gatekeeper" model typically used by health maintenance organizations to control access to and coordinate specialist care is ineffective. The generalist PCP cannot be expected to have knowledge that is sufficiently deep to play the role of coordinator. Wiggins aims to replace it with an approach that connects patients to teams of specialists and health care facilities that have contracted with Oxford to provide total care for particular conditions or "cases," from start to finish. The success of this model rests in part on the ability of specialists and health care facilities to agree contractually on how to split the pie among themselves. But beyond that starting point, it rests on the ability of these distinct entities, each with its own specialized knowledge, to coordinate care more effectively than the generalist PCP. Will this model, on which Wiggins claims to have "bet the company," succeed?