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Related Experiment Videos

Making risk contracting work in specialty networks.

R W Krohn1

  • 1Medical Alliances, Alexandria, VA 22314, USA.

Medical Group Management Journal
|December 8, 1996
PubMed
Summary

Specialty networks must adapt to capitation payment models by quantifying service costs and managing utilization. This approach is key for success in evolving healthcare contracting and risk arrangements.

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Area of Science:

  • Healthcare administration
  • Health economics
  • Specialty care management

Background:

  • Capitation is increasingly impacting healthcare contracting for specialty providers.
  • Specialty networks face a shrinking market and consolidating delivery systems.
  • Accepting capitation may be essential for network viability.

Purpose of the Study:

  • To explore risk contracting within specialty networks.
  • To identify essential infrastructure for successful risk contracting.
  • To guide specialists in navigating capitation and risk-based payment models.

Main Methods:

  • Analysis of current trends in healthcare contracting.
  • Evaluation of financial and operational requirements for risk contracting.
  • Framework development for investigating specialty network risk contracting.

Main Results:

  • Specialties that can quantify service costs and manage utilization are best positioned for risk contracting.
  • Effective disease management, patient intervention, and wellness programs are crucial.
  • Infrastructure for cost analysis and utilization management is vital for success.

Conclusions:

  • Specialty networks must proactively investigate and prepare for risk contracting.
  • Successful adaptation requires robust data analytics and care management capabilities.
  • Strategic positioning within capitation models is necessary for long-term success.

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