Underwriting: a key to healthy capitation agreements.
In some markets, healthcare providers in integrated delivery systems have been assuming full-risk capitated contracts. Some of these contracts have been profitable, but others have produced inconsistent financial results. These results may reflect inadequate underwriting practices. For providers and HMO insurers to establish financially successful capitation agreements, they must develop and audit an underwriting process to evaluate the health risk of the population entering the managed care system.
Dameron
T H
TH
Healthcare Consulting Group, Arthur Andersen & Co., Seattle, WA, USA.
Fessler
J C
JC
D002204:Capitation Fee; D003669:Deductibles and Coinsurance; D005376:Financial Management / Q000379:methods*; D006279:Health Maintenance Organizations / Q000191:economics*; D006305:Health Status Indicators; D006801:Humans; D018570:Risk Assessment; D014481:United States