Understanding and managing integrated delivery networks.
This article presents a guide for "managing managed care." To be successful in the transition from the fee-for-service payment system to capitation, the manager first needs to understand the five roles (the players), and their integration. The five roles are the employer, the insurer, the primary care physician, the specialist physician, and the hospital. Once a health care manager understands the dynamics between these roles and their involvement in operations such as finance, contracting, and utilization review, managed care can then be managed. This guide is also beneficial to managers for understanding how to work with someone in another role.
Kiel
J M
JM
Department of Health Management Systems, Duquesne University, Pittsburgh, Pennsylvania, USA.
D019033:Delivery of Health Care, Integrated / Q000191:economics / Q000458:organization & administration*; D006761:Hospitals; D008329:Managed Care Programs; D011320:Primary Health Care; D014600:Utilization Review