Provider Organizations At Risk : A Profile
نویسنده
چکیده
With the growth of managed care and market competition, a diverse set of largely provideraffiliated organizations has emerged to mediate risk and care management responsibility between managed care organizations and individual providers. Emerging evidence shows that some of these organizations are under duress and that others have actually failed. Policymakers need to know more about the organizations that assume financial risk so that they can better gauge both the possible advantages and the potential risks that stem from this marketplace development and what they might do to encourage the former and protect against the latter. This paper provides a nationwide look at the characteristics of these organizations, the responsibilities they bear, and how they perceive their responsibilities and their future role in the arrangements they have assumed with health plans.
منابع مشابه
Governance Must Dive Into Organizations to Make a Real Difference; Comment on “Governance, Government, and the Search for New Provider Models”
In their 2016 article, Saltman and Duran provide a thoughtful examination of the governance challenges involved in different care delivery models adopted in primary care and hospitals in two European countries. This commentary examines the limited potential of structural changes to achieve real reform and considers that, unless governance arrangements actually succeed in penetrating organizatio...
متن کاملThe Role of Economic-Occupational Welfare Organizations in Risk-Prevention Groups in Prevention of Commodity and Currency Trafficking
The welfare of groups at risk, including staff engaged in the fight against trafficking in goods and currencies, as one of the social prevention strategies can play an effective role in preventing the occurrence of trafficking-related offenses. Given the economic nature of the crime of trafficking in commodities and currencies, the amount of public and welfare services provided by the governmen...
متن کاملMicroarray-Based Gene Expression Profile Testing for Multiple Myeloma Risk Stratification
Prior Authorization Information Pre-service approval is required for all inpatient services for all products. See below for situations where prior authorization may be required or may not be required for outpatient services. Yes indicates that prior authorization is required. No indicates that prior authorization is not required. N/A indicates that this service is primarily performed in an inpa...
متن کاملHealth Insurance Coverage at Midlife: Characteristics, Costs, and Dynamics
Recent data from the first two waves of the Health and Retirement Study are analyzed to evaluate prevalence of different types of health insurance, characteristics of different plan types, and change sin coverage as individuals approach retirement age. Although overall rates of coverage are quite high among the middle-aged, the risk of noncoverage is high within many disadvantaged groups, inclu...
متن کاملRisk selection in the Massachusetts State employee health insurance program.
Using the Diagnostic Cost Group (DCG) model developed from a national sample, we examine biased selection among one fee-for-service (FFS) plan, one preferred provider organization, and several health maintenance organizations (HMOs) in Massachusetts. The proportions of enrollees in low-risk groups are higher in the HMO plans and lower in the FFS plan. The average age in the FFS plan is 9 years ...
متن کامل