Today's managed care market

Article Abstract:

Many health maintenance organizations (HMOs) depend on their primary care physicians (PCP) in managing the volume and intensity of medical care. Studies show that PCPs could be the major care provider in attending to 70% of all cases for individuals below 65. PCPs play a minor role in treating less prevalent medical conditions. There is doubt of whether PCPs can influence the overall treatment pattern after patient referral. HMOs must come up with other management techniques to control in medical care costs.

Health Care, Health Care and Social Assistance, Finance, Medical care

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Today's managed care market: characteristics needed for vertically integrated health systems to deliver efficient medical services

Article Abstract:

Physicians can maintain their patient base and compete against health maintenance organizations (HMOs) by establishing alliances with physician groups and hospitals. At present, more than 650 such alliances, also known as vertically-integrated health systems have been organized. These health systems have more than 100 physicians in their groups and they have full-risk capitation agreements with HMOs. A system by which integrated health systems can efficiently deliver medical services is described.

Practice, Physicians, Medical professions

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Today's managed care market

Article Abstract:

Physician groups can increase profits derived from group medical practice by using accurate International Classification of Disease, 9th Revision (ICD.9)-coded information. First, ICD.9 codes are used to formulate patient-specific capitation rates. Second, they are utilized to compensate doctors for quality and cost efficient care. Third, risk-adjustment systems can be created and fourth, the right composition and number of doctors can be hired.

Economic aspects, Managed care plans (Medical care), Group medical practice

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