Pricing medical services in the managed care environment
Article Abstract:
The portfolio approach to financial management in the managed care environment is necessary to determine sound prices for managed care contracts and to meet an organization's total financial requirements. Portfolio management, which permits differentiation of accounts to enable application of other management techniques to the payer mix, involves determining risk factors associated with pricing mechanisms to prevent contract losses. The importance of pairing utilization and pricing review in managed care contacts are discussed.
Publication Name: Topics in Health Care Financing
Subject: Health care industry
ISSN: 0095-3814
Year: 1992
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Insolvency in managed care organizations: financial indicators
Article Abstract:
Am examination of the financial history of health maintenance organizations (HMO) reveals the financial risks involved in the administration of managed care organizations. The risks which HMO's and other managed care organizations must address to prevent insolvency are presented and discussed. In addition, the indicators which determine financial solvency and by which HMO's can evaluate their financial strength and viability are presented.
Publication Name: Topics in Health Care Financing
Subject: Health care industry
ISSN: 0095-3814
Year: 1992
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