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Related Experiment Videos

Medicare risk contracts--success or failure?

F J Wenzel, J Malcolm

    Medical Group Management
    |April 10, 1986
    PubMed
    Summary

    New legislation boosts risk contracting popularity. A 1980 demonstration by the Health Care Financing Administration informed current capitation programs, offering insights for groups entering Medicare risk contracts.

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    Area of Science:

    • Healthcare Administration
    • Health Economics
    • Public Policy

    Background:

    • Recent legislation has increased interest in risk-based contracting within the healthcare sector.
    • A 1980 demonstration by the Health Care Financing Administration (HCFA) laid groundwork for current capitation programs.
    • Understanding different provider models is crucial for navigating risk contracts.

    Purpose of the Study:

    • To discuss significant issues for organizations considering Medicare risk-based contracts.
    • To provide insights from a medical group practice and a health maintenance organization involved in a demonstration program.
    • To highlight the impact of the HCFA demonstration on contemporary capitation models.

    Main Methods:

    • Analysis of perspectives from administrators at Marshfield Clinic and MedCenters Health Plan.
    • Review of experiences from a demonstration program initiated in 1980.
    • Discussion of key challenges and considerations for risk contracting.

    Main Results:

    • Insights from both a medical group practice and a health maintenance organization are presented.
    • The study identifies critical factors for successful Medicare risk-based contracting.
    • The 1980 HCFA demonstration provided valuable input for current capitation programs.

    Conclusions:

    • Organizations considering Medicare risk contracts should carefully evaluate significant issues.
    • The perspectives of diverse healthcare entities are essential for understanding risk contracting.
    • The historical HCFA demonstration offers lessons for current healthcare financing models.

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