Success in managed care: improving clinical quality.
What are the economic elements for success in managed care? Although they are quite simple, achieving them can be difficult. The criteria for success in the fee-for-service medical delivery system, generally characterized as "see more--do more--get more," are no longer valid for delivering care in a managed care system. This article identifies the economic elements for success in managed care, and offers a disciplined approach to achieving them, combining both actuarial and clinical expertise.
Cigich
S M
SM
Wausau Insurance, WI, USA.
Mischler
N E
NE
D003363:Cost Control; D019033:Delivery of Health Care, Integrated / Q000191:economics / Q000458:organization & administration / Q000592:standards; D003953:Diagnosis-Related Groups; D017598:Efficiency, Organizational; D006264:Health Benefit Plans, Employee / Q000592:standards; D006801:Humans; D007902:Length of Stay; D008329:Managed Care Programs / Q000191:economics / Q000458:organization & administration / Q000592:standards*; D008485:Medical Audit; D010818:Practice Patterns, Physicians'; D017009:Professional Autonomy; D012308:Risk Management; D017749:Total Quality Management / Q000379:methods*; D014481:United States