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A Cherney

Publications and source records attributed to A Cherney.

5 recordsLinked to original sources

Coming to grips with risk-sharing: capitation in the long-term care industry.

"Risk" means the transference of the financial payment for specified services from one entity to another. Risk transfers can occur from payers to providers or between providers. Risk can be transferred through a number of different payment structures. The concept of sharing risk originated several decades ago as employers began to tighten their health care budgets. Meticulous attention to details is a necessity if risk contracting is to be a profitable venture for long-term care providers. Long-term care providers are in different stages of development with risk-sharing contracting. With some attention to detail, the formation of the right team, and an understanding of costs, ancillary provider risk sharing can be profitable for all partners involved. This article details issues that should be considered before entering into a risk-sharing arrangement.

Aged↗

Choosing an advantageous risk-sharing arrangement.

Providers entering into risk-sharing arrangements with managed care organizations have several options regarding the amount of risk they can assume. The four most common forms of arrangements are based on service guarantees, case rates, episode rates, and global capitation. Providers must determine carefully which of these arrangements is most beneficial for them.

Capitation Fee↗

Managed care and the infectious diseases specialist.

There is growing demand to contain health care costs and to reassess the value of medical services. The traditional hospital, academic, and research roles of the infectious disease (ID) specialist are threatened, yet there is an increasing need for expertise because of growing antimicrobial resistance and emerging pathogens. Opportunities exist to develop and expand services for the care of patients infected with human immunodeficiency virus and in infection control, epidemiology, outcomes research, outpatient intravenous therapy, and resource management. It is important for ID physicians to appreciate the principles involved in managed care and the areas in which ID services can be valuable. To be effective, physicians need to know about tools such as practice guidelines, physician profiling, outcomes monitoring, computerized information management, risk sharing, networking, and marketing, as well as related legal issues. With a positive attitude toward learning, application, and leadership, ID physicians can redefine their role and expand their services through managed care.

Ambulatory Care↗