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Related Experiment Videos

Improve--rather than lose--your risk-taking entity.

F M Prescott1

  • 1First Health Associates, Inc., Ann Arbor, Michigan, USA.

Healthcare Financial Management : Journal of the Healthcare Financial Management Association
|August 18, 2000
PubMed
Summary
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Health maintenance organizations (HMOs) shifting financial risk to provider organizations can lead to financial and administrative challenges. Financial managers must monitor key indicators to prevent potential losses.

Area of Science:

  • Healthcare Management
  • Financial Risk Management
  • Provider Contracting

Background:

  • Health maintenance organizations (HMOs) increasingly transfer financial risk to provider organizations.
  • This transfer often includes administrative functions like claims processing.
  • Provider risk-taking entities include physician-hospital organizations (PHOs) and independent physician associations (IPAs).

Purpose of the Study:

  • To inform financial managers about potential financial risks when HMOs transfer risk to providers.
  • To highlight the importance of monitoring medical costs, pricing, and underwriting.
  • To emphasize the need for awareness of administrative efficiency impacts.

Main Methods:

  • Analysis of financial risk transfer mechanisms in HMO-provider relationships.

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  • Identification of key financial indicators and processes.
  • Review of administrative function responsibilities.

    • Main Results:

    • Provider organizations face financial risks in medical costs, pricing, and underwriting.
    • Administrative efficiency is a critical factor alongside financial risk.
    • Early identification of problems is crucial for loss prevention.

    Conclusions:

    • Financial managers in provider organizations need to be vigilant about risks transferred from HMOs.
    • Monitoring financial and administrative performance is essential for proactive management.
    • Implementing robust processes to identify potential losses is recommended.