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PubMed · 10164652

Value-based formulas for purchasing. PEHP's designated service provider program: value-based purchasing through global fees.

D W Emery
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Abstract

In many circles, managed care and capitation have become synonymous; unfortunately, the assumptions informing capitation are based on a flawed unidimensional model of risk. PEHP of Utah has rejected the unidimensional model and has therefore embraced a multidimensional model of risk that suggests that global fees are the optimal purchasing modality. A globally priced episode of care forms a natural unit of analysis that enhances purchasing clarity, allows providers to more efficiently focus on the Marginal Rate of Technical Substitution, and conforms to the multidimensional reality of risk. Most importantly, global fees simultaneously maximize patient choice and provider cost consciousness.

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Actuarial AnalysisCapitation FeeChoice BehaviorCompetitive Medical PlansEpisode of CareGroup PurchasingHealth Benefit Plans, EmployeeHumansModels, OrganizationalPower, PsychologicalProgram EvaluationState GovernmentUtahJournal Article

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D W Emery. 1997. Value-based formulas for purchasing. PEHP's designated service provider program: value-based purchasing through global fees.. https://pubmed.ncbi.nlm.nih.gov/10164652/

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