Risk pools: payers and providers take the plunge.
Providers considering managed care risk pool arrangements should understand thoroughly what services the pool covers, the time period covered, and how the pool is administered. Important issues related to pool administration include how credits and debits are applied; when the accounting occurs (interim, year-end, or contract termination); and provisions for reports, audit rights, and dispute resolution. Although a pool arrangement gives the health plan control over claims payment, the risk allocation made possible through a pool arrangement helps ensure that the economic incentives of the health plan and the provider are aligned.
Hummel
J R
JR
Greensfelder, Hemker & Gale, P.C., St. Louis, Missouri, USA.
D002204:Capitation Fee; D018588:Fee-for-Service Plans; D005249:Fees and Charges; D007344:Insurance Claim Reporting; D015271:Insurance Pools / Q000191:economics / Q000458:organization & administration*; D008329:Managed Care Programs / Q000191:economics*; D020414:Risk Sharing, Financial; D014481:United States