BURLINGTON, Mass.-A partnership between the Lahey Clinic, a multispecialty group practice, and Harvard Community Health Plan has secured its first community-based primary-care clinic. The partnership was formed in September 1993 to develop a joint network of physician group practices. Lexington (Mass.) Medical Associates, a five-physician practice, will become part of the Burlington-based Lahey Clinic's staff. It also will become part of Harvard Community's physician network, which now includes more than 70 group practices and health centers. The Lexington practice will continue to provide services for other health plans under existing relationships. Harvard Community is a 565,000-enrollee health maintenance organization based in Brookline, Mass.
NEW YORK-The U.S. District Court here has struck down a state rule that compensates certain insurance companies for enrolling older and sicker people, compared with the younger, healthier enrollees of health maintenance organizations. In a suit against state Insurance Commissioner Salvatore Curiale, the New York State Health Maintenance Organization Conference and 14 individual HMO plans said the state's system of pooling revenues for such compensation resulted in premium increases of as much as 6% for their individual and small-group customers. Because of the rule-which is part of the state's April 1993 insurance reform law-HMOs have placed $15 million in escrow. The court said the rule violates the federal Employee Retirement Income Security Act. The state plans to appeal the decision.
POUGHKEEPSIE, N.Y.-Physical Therapy Provider Network, a preferred provider organization based in Woodland Hills, Calif., is adding a New York franchise. As many as 100 physical therapy offices will be part of the franchise, the largest of seven across the United States. "New York is a key state for us because of its sizable managed-care marketplace," said Michael Weinper, president of the specialty PPO. Dennis Silverbloom, president of the New York franchise, said it's difficult for independent physical therapists to contract with payers unless they are part of a network. PTPN was formed in 1985 and now covers 6 million lives and manages $16 million in claims volume annually.