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PubMed1993

Threats to consumers.

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Competitive Medical Plans↗
PubMedDate not supplied

The ABCs of HIPCs (health insurance purchasing cooperatives).

HIPCs, or health care purchasing cooperatives, are attracting widespread interest as a key element of the managed competition approach to health reform. HIPCs perform several useful roles for individuals and small employers unable to obtain health insurance coverage in the current system by spreading risk more evenly and purchasing coverage in a given region or market area. While HIPCs are generally associated with managed competition, they are also compatible with reform strategies that require employers to pay for coverage or those that provide incentives for expanded coverage.

Costs and Cost Analysis↗
PubMedDate not supplied

Independent practice associations: risk contracting, financial controls and processes.

The decision to enter into risk contracting with a health plan should be carefully considered. With today's pressure to control health care costs, an IPA's financial position can change rapidly. Even small numbers of enrollees can precipitate losses of hundreds of thousands of dollars over a few months if utilization and costs are not carefully projected and monitored. Prudent contracting to limit the IPA's downside risk in a new contract's early years is the most effective tool for preserving financial stability. However, the IPA must also develop sophisticated claims processing and financial reporting systems to ensure consistent payment practices and enable management to identify problem areas rapidly. Contracts with physician providers must allow the IPA flexibility in implementing administrative withholds and in renegotiating rates with short lead times.

Capitation Fee↗
PubMedDate not supplied

Successful implementation of Medicare risk contracting.

With the information resources available today, groups can better determine whether they possess the ingredients for success with regard to risk contracting, write Molly Zelley, M.P.A., and Christy Bell. For those that do, Medicare risk contracting can be a vehicle for developing comprehensive, cost-effective new approaches for attracting and providing health care to this increasingly significant segment of the population.

Aged↗