Ambulatory care groupings: when, how, and the impact on managed care.
This article explores case-mix adjustment systems in the ambulatory care environment as applied by managed care firms. An overview of ambulatory care groupings or ambulatory case-mix systems is given, and the special case-mix adjustment needs of managed care companies are reviewed. Generally, two types of ambulatory care grouping systems are available: encounter-based and population-based. Case examples of three managed care companies that are currently investigating the use of population-based case-mix systems are used to demonstrate the possible use of such systems in the managed care environment such as physician profiling and capitation rate setting.
Kolb
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DS
Jennings Ryan & Kolb, Atlanta, GA.
Clay
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SB
D000553:Ambulatory Care / Q000145:classification*; D000555:Ambulatory Care Information Systems; D002017:Budgets / Q000458:organization & administration; D003625:Data Collection / Q000379:methods; D003953:Diagnosis-Related Groups / Q000145:classification*; D008329:Managed Care Programs / Q000706:statistics & numerical data*; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data; D017062:Small-Area Analysis; D012984:Software; D014481:United States