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Kaiser Permanente: integrating around a care delivery model.

J Slaughter1

  • 1Kaiser-Permanente, San Rafael, California, USA.

The Journal of Ambulatory Care Management
|September 30, 2000
PubMed
Summary

The Balanced Budget Act of 1997 mandates a Medicare + Choice risk-adjusted payment model. This requires significant data capture improvements in ambulatory care, posing challenges for California healthcare organizations lacking capital and technology.

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Area of Science:

  • Health Services Research
  • Health Economics
  • Healthcare Management

Background:

  • The Balanced Budget Act of 1997 introduced a risk-adjusted payment model for Medicare + Choice organizations.
  • This model necessitates a shift in focus towards capturing data on chronic medical conditions within the ambulatory care setting.

Purpose of the Study:

  • To analyze the implications of the Medicare + Choice risk-adjusted payment model on healthcare organizations.
  • To identify challenges in data capture and operational adjustments required for compliance.

Main Methods:

  • Analysis of the regulatory requirements of the risk-adjusted payment model.
  • Assessment of the current technological and financial capabilities of healthcare organizations in California.
  • Evaluation of the impact on private practitioners' data management.

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Main Results:

  • Healthcare organizations require substantial retooling of ambulatory care operations for data capture.
  • California healthcare organizations face capital limitations for necessary information management tools.
  • Private practitioners lack the requisite technology and expertise for the model's data demands.

Conclusions:

  • The risk-adjusted payment model presents significant operational and financial challenges for healthcare providers.
  • Successful implementation requires investment in information management and technology.
  • The model offers potential for improved integrated care delivery based on population health needs.