Management Competencies Required on Ambulatory Care Settings. (Physician Executive Management Competencies)‪.‬

THE INTEGRATION OF FINANCING AND HEALTH services delivery under the explosive growth of managed care has become a dominant characteristic of American health care. (1, 2, 3 Massive, market-based reform has rapidly transformed the traditional, provider-driven, loosely associated system of solo practitioners, small medical groups, and free-standing community hospitals (4) into a payer-driven, "corporatized" world of hospital systems and large group practices. (5) These systems are being dominated increasingly by multi-state insurance companies and large, investor-owned managed care companies. (6, 7) Frustrated by failures to control enormous escalation in health care costs under the "perverse" incentives of indemnity-based fee-for-service, corporate America and our political leaders have embraced a "common wisdom" that managed care in a competitive marketplace will effectively control the problem of rising costs, while maintaining acceptable levels of quality and access.