PPO services and formulary types

September 1, 2007

PPOS are seeing a continued resurgence in some areas, and in others, are not able to compete effectively with HMOs, industry experts say.

PPOS ARE EXPERIENCING a continued resurgence in some areas, and in others, are not able to compete effectively with HMOs, industry experts say.

Healthcare Benefits Consultant F. Randy Vogenberg, RPh, PhD, chief strategic officer and co-founder of Employer-based Pharmaceutical Strategies, LLC, based in Cranston, Rhode Island, agrees that PPOs need to differentiate their networks within the marketplace so that employers get a sense of receiving value for their premium dollars.

PPO SERVICES

According to Paduda, there is continued interest in ancillary care services, but it is geographically specific.

"For example, there is likely more interest in wellness and chiropractic in some areas than in others," he explains. "PPOs looking to expand market share in specific areas would do well to carefully research each area they operate to determine what potential customers are seeking."

As far as PPO formulary types go, there appears to be no differentiation or value seen in formulary decisions by PPOs at this point, with only a handful of exceptions, according to Dr. Vogenberg.

"Care quality and premium value remains elusive to payers," he says.

-Tracey WalkerCommentary is independent of source data