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Development of provider networks for specific diseases
R J Pristave1, S Becker, L Gutierrez
1Health Care Department, Ross & Hardies, Chicago, Illinois, USA.
Journal of Health Care Finance
|January 1, 1995
Summary
Carve out contracting, a strategy for managing specific diseases and specialty services, aims to improve care and cost control. This approach places management responsibility with expert providers, applicable across various conditions.
Area of Science:
- Healthcare Management
- Health Economics
- Contract Law
Background:
- Carve out contracting has rapidly increased for specialty services and specific diseases.
- This contracting model aims to enhance care management and cost efficiency.
- Identifying the most suitable entities for managing care and associated expenses is key.
Purpose of the Study:
- To provide an overview of carve out contracting for specific diseases.
- To examine the business and legal aspects of carve out contracts.
- To illustrate the applicability of these principles to a wide range of diseases.
Main Methods:
- Review of current trends in healthcare contracting.
- Analysis of business and legal frameworks for carve out arrangements.
- Case examples focusing on Acquired Immunodeficiency Syndrome/Human Immunodeficiency Virus (AIDS/HIV) and End-Stage Renal Disease (ESRD).
Main Results:
- Carve out contracting is a prevalent strategy in healthcare.
- The model centralizes responsibility for care and cost management.
- Specific disease carve outs, like those for AIDS/HIV and ESRD, highlight the model's potential.
Conclusions:
- Carve out contracting offers a structured approach to managing complex health conditions.
- The business and legal principles are transferable across different disease states.
- This strategy can optimize both the quality and cost of care for targeted populations.