The Community Medical Alliance: an integrated system of care in Greater Boston for people with severe disability and AIDS.
The Community Medical Alliance in Boston has adapted principles of prepaid managed care to redesign service delivery for people with severe physical disability and with late-stage AIDS. Experience to date suggests that the flexibility of capitation can be used to substantially shift care from its usual hospital focus to clinicians in home and community settings, especially nurse practitioners, with a high degree of patient satisfaction and without apparent compromise in quality. Instead of limiting access, managed care can use prepayment to support early interventions, coordination, and the development of services specifically designed to meet the needs of the target population.
Master
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Medicaid Working Group, Boston, MA 02116, USA.
Dreyfus
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Connors
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Tobias
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Zhou
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Kronick
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D000163:Acquired Immunodeficiency Syndrome / Q000628:therapy*; D001900:Boston; D002204:Capitation Fee; D018672:Community Health Planning / Q000458:organization & administration*; D019033:Delivery of Health Care, Integrated / Q000191:economics / Q000458:organization & administration* / Q000706:statistics & numerical data; D006233:Persons with Disabilities; D017048:Health Care Costs; D006291:Health Policy; D006801:Humans; D008329:Managed Care Programs / Q000191:economics / Q000458:organization & administration / Q000706:statistics & numerical data; D009722:Nurse Practitioners; D017060:Patient Satisfaction; D015397:Program Evaluation; D017749:Total Quality Management; D014600:Utilization Review