Given the differences, there is a strong temptation to think that the evolutionary theory of managed care applies to IPAs you know, the theory that California is the crest of the evolutionary wave, and what you see in California will wash over the rest of the country in the next 10 years or so. Resist. If one accepts that medical care is local, then what we may have are different medical environments just as we have mountains and seashores and deserts and the local medical tribes are adapting to their own environments without blindly adopting whatever pops up on the West Coast.
Moreover, it is a mistake to assume that IPAs everywhere else are primitive. By almost any measure we've seen from any of the plans we deal with, that our affiliates have higher levels of patient satisfaction, and they come out higher on any type of quality indicator, and their costs are almost always 12 to 15 percent below whatever business they don't control.