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S B Clay

Publications and source records attributed to S B Clay.

7 recordsLinked to original sources
PubMed1998

Medicare+Choice PSO formation: a step-by-step decision process.

The introduction of the Medicare + Choice program has opened up new opportunities for healthcare providers to contract directly with Medicare through provider-sponsored organizations (PSOs). Because the time, resources, and risks inherent in forming and operating a Medicare + Choice PSO are substantial, providers should approach this new opportunity methodically. A seven-step process can take providers from assessment to contract application.

Capitation Fee↗
PubMed1997

Provider-sponsored HMOs: make, buy, or joint venture?

Providers can sponsor their own HMOs in one of three ways: by creating their own HMO, by joint venturing with an existing HMO, or by purchasing an existing HMO. When selecting the best option, providers must consider various market conditions. Managed care penetration in the area, potential competitive responses of existing HMOs, market demand, provider reputation, and provider marketing ability will all influence the feasibility of each option. Providers also must examine their own organizational identity, their ability to raise the necessary capital to start an HMO, their managed care expertise and risk contracting experience, and their information systems capabilities.

Capital Financing↗
PubMed1994

Ambulatory care groupings: when, how, and the impact on managed care.

This article explores case-mix adjustment systems in the ambulatory care environment as applied by managed care firms. An overview of ambulatory care groupings or ambulatory case-mix systems is given, and the special case-mix adjustment needs of managed care companies are reviewed. Generally, two types of ambulatory care grouping systems are available: encounter-based and population-based. Case examples of three managed care companies that are currently investigating the use of population-based case-mix systems are used to demonstrate the possible use of such systems in the managed care environment such as physician profiling and capitation rate setting.

Ambulatory Care↗