Managing quality from the utilization management perspective: the provider view.
As a contracted provider for a popular health maintenance organization, you receive notice that it is converting its provider contracts to capitated reimbursement models. Reluctantly, you read to see how this change affects your practice. Are you positioned to accept "risk" for your patients? How will you manage your risk? Can you afford to terminate your relationship with this managed care organization and lose your patients to providers who are eager to expand their practice and patient base? This article presents an overview of capitation and ways to manage capitation while promoting quality care and outcomes for your patients.
Miles
K S
KS
Vanderbilt Health Services, Vanderbilt University Medical Center, Nashville, TN 37203, USA.
D002204:Capitation Fee; D019090:Case Management / Q000458:organization & administration; D006282:Health Personnel / Q000458:organization & administration*; D006801:Humans; D008329:Managed Care Programs / Q000458:organization & administration*; D010351:Patient Discharge; D012017:Referral and Consultation; D017749:Total Quality Management / Q000458:organization & administration*; D014600:Utilization Review / Q000458:organization & administration*