Capitation Sourcebook

by Peter Boland

Lower your costs while improving patient care. Capitation is playing an increasingly important role in the development of new business for both providers and insurers. Presented in an easily... This description may be from another edition of this product.

• Format: Paperback
• Language: English
• ISBN: 0965271706
• ISBN13: 9780965271707
• Release Date: January 1996
• Publisher: Boland Healthcare
• Length: 668 Pages
• Weight: 2.30 lbs.
• Dimensions: 1.4" x 6.0" x 9.1"

Customer Reviews

Very comprehensive guide to health care capitation payments

THE CAPITATION SOURCEBOOK: A Practical Guide To Managing At-Risk ArrangementsCapitation presents a unique dilemma to health care information executives grappling with increased demands for more data and information processing capability while revenue continues to decline at their institutions. This is the reality of managed care today.A comprehensive new book, THE CAPITATION SOURCEBOOK: A Practical Guide To Managing At-Risk Arrangements, published by Boland Healthcare, describes the challenge of capitated reimbursement to lower costs and improve care at the same time. In six hundred plus pages and thirty chapters written by operational experts in the field, it explains how to manage risk more efficiently and how to design information systems to better meet the needs of patients, practitioners, and managed care organizations. This is a daunting task particularly for health care systems and providers making the transition from fee-for-service to risk sharing arrangements. The Capitation Sourcebook includes over a hundred tables and many figures that illustrate the types of information required by organizations to be successful in managing different risk arrangements. However, the book goes far beyond a traditional facts and figures approach. It presents a conceptual framework for understanding why capitation is now the driving force in managed health care and what this means in terms of operational and clinical requirements for day-to-day managers. Information is key and the primary mechanism for aligning financial incentives among providers and redesigning patient care systems in order to reduce costs.The book is rich in content. It challenges CIOs to rethink how to manage data and information to create the necessary knowledge base for institutions involved in risk contracts. It points to dozens of case studies where key stakeholders -- physicians, hospitals, and delivery systems -- have been successful in building collaborative financial models that distribute risk and income equitably. The authors demonstrate that success depends on a philosophical commitment to better care, a business strategy that drives operational efficiency, and an information system that supports accountability and timely feedback.Part one of the book introduces the main themes of performance accountability and business strategy. Part two details how to align performance and payment criteria. Part three explains a number of practical techniques for managing the transition to prepaid incentives and physician compensation models for phasing in capitation. It also includes the information components required to manage Medicaid capitation. Part four focuses on the information requirements and financial controls for managing provider networks. Part five deals with clinical resource consumption and utilization management issues. Part six describes negotiation principles and actuarial cost models to evaluate contracts.