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Related Experiment Videos

Success in managed care: improving clinical quality.

S M Cigich1, N E Mischler

  • 1Wausau Insurance, WI, USA.

Physician Executive
|March 8, 1997
PubMed
Summary
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Achieving economic success in managed care requires a shift from fee-for-service models. This involves integrating actuarial and clinical expertise for a disciplined approach to new economic criteria.

Area of Science:

  • Health economics
  • Healthcare management

Background:

  • The traditional fee-for-service model, driven by "see more--do more--get more," is obsolete in managed care.
  • Managed care systems necessitate different economic strategies for success.

Purpose of the Study:

  • To identify the key economic elements crucial for success within managed care environments.
  • To propose a structured methodology for achieving these economic success factors.

Main Methods:

  • Analysis of economic principles applicable to healthcare delivery.
  • Integration of actuarial data with clinical practice insights.

Main Results:

  • Identification of specific, albeit simple, economic criteria for managed care success.

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  • Development of a disciplined approach combining financial and clinical perspectives.

    • Conclusions:

    • Success in managed care hinges on understanding and implementing distinct economic principles.
    • A combined actuarial and clinical strategy is essential for navigating managed care economics.