A model to manage capitated risk.
The impact of increasing enrollment in Medicare HMOs will require health care providers to develop new strategies in care delivery systems. Key strategies in managing risk include health risk appraisals, proactive case management, disease management, provider education, and the use of inpatient physician managers. Implementing an integrated care management system requires a team approach. The physician inpatient manager, nurse case manager, geriatric clinical nurse specialist, and social worker composed the health care team charged with implementing a care management system responsive to enrollees' needs. A quality management plan is essential for tracking patient outcomes and quality indicators across the continuum. The focus of promoting wellness and preventing illness represents a paradigm shift from the traditional model of episodic care that can yield positive financial results.
Moss
J K
JK
Patient Care Services and Performance Improvement, Highland Park Hospital, Highland Park, IL, USA.
Steiner
K
K
Mahnke
K
K
Cohen
R
R
D002204:Capitation Fee; D019090:Case Management / Q000458:organization & administration*; D019033:Delivery of Health Care, Integrated; D006801:Humans; D008329:Managed Care Programs / Q000458:organization & administration*; D018803:Models, Economic; D012308:Risk Management / Q000458:organization & administration*