title: Performance under capitation: the true cost of infrastructure.
abstract: Administrative costs are a major item of concern for capitated provider groups, who must maintain a sophisticated infrastructure to allow them to manage and deliver clinical care to their patients under a fixed budget. The cost of this infrastructure is under steady upward pressure, as HMOs delegate more activities to providers and step up their reporting requirements. Our experience in establishing an infrastructure for a provider network is reported, and indicates substantial costs for both start-up and ongoing operations, which are highly volume dependent. A powerful case exists in favor of centralizing and pooling administrative infrastructure across related provider groups.
authors.affiliation: Accord Health Network, Westchester, IL, USA.
authors.forename: B F
authors.initials: BF
authors.lastname: VanderLaan
authors.forename: M
authors.initials: M
authors.lastname: de la Houssaye
authors.forename: K
authors.initials: K
authors.lastname: Janousek
authors.forename: C
authors.initials: C
authors.lastname: Derus
mesh_terms: D002017:Budgets; D002204:Capitation Fee; D019090:Case Management; D003361:Cost Allocation; D004465:Economic Competition; D005376:Financial Management / Q000379:methods*; D006279:Health Maintenance Organizations / Q000191:economics* / Q000458:organization & administration*; D007256:Information Systems / Q000458:organization & administration; D012308:Risk Management; D014481:United States; D000078329:Workforce