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Physician practice reengineering as attributed to managed care contracting
1Department of Health Management Systems, Duquesne University, Pittsburgh, USA.
Managed Care Interface
|February 24, 2001
Summary
Capitation offers a cost-effective healthcare payment model. Physicians must understand contract details beyond reimbursement when partnering with managed care organizations (MCOs) for successful agreements.
Area of Science:
- Healthcare Economics
- Medical Practice Management
Background:
- Fee-for-service models are being challenged by capitation.
- Managed care organizations (MCOs) are increasingly prevalent in healthcare delivery.
Purpose of the Study:
- To highlight key considerations for physicians contracting with MCOs.
- To emphasize factors beyond reimbursement influencing contract success.
Main Methods:
- Analysis of healthcare payment models.
- Review of managed care contracting principles.
Main Results:
- Capitation presents a financially sound alternative to fee-for-service.
- Contractual success depends on multifaceted considerations, not solely reimbursement.
Conclusions:
- Physicians need comprehensive understanding of MCO contracts.
- Strategic evaluation of all contract terms is crucial for practice viability.