Integrated systems: subspecialists as capitated primary care physicians?

The shortage of primary care physicians, the shifting roles of specialists and abundance of subspecialists are challenging hospital alliances. In the new world of managed care and managed competition, where providers assume financial risk for overutilization, management must discard traditional measures of profitability and focus on adding value. Hospitals are taking steps to become accountable health partners in smaller to mid-sized markets (two or three hospitals) by sponsoring community based direct contracting managed care networks. This type of system helps providers offer employers a local managed care alternative that is better able to demonstrate quality of care, and to control utilization through capitation and other pricing strategies.