Dispelling managed care myths.
Mead Jennings, Cathy Sullivan Clark
Abstract
Mead Jennings, Cathy Sullivan Clark
Abstract
A number of ideas regarding managed care and capitation are commonly accepted as truths. In reality, however, these ideas are half-truths or myths. Healthcare providers need to challenge some of these myths in order to respond proactively to change. Some of the traditional thinking about managed care that needs realignment includes the belief that PHOs essentially are transitional vehicles and not viable, long-term solutions; that the incentives under fee-for-service payment conflict totally with the incentives under capitation; that under global capitation, the best method for paying primary care physicians is capitation and the best way to pay specialists is discounted fee-for-service; and that small, exclusive physician panels are the most successful for managed care.
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A number of ideas regarding managed care and capitation are commonly accepted as truths. In reality, however, these ideas are half-truths or myths. Healthcare providers need to challenge some of these myths in order to respond proactively to change. Some of the traditional thinking about managed care that needs realignment includes the belief that PHOs essentially are transitional vehicles and not viable, long-term solutions; that the incentives under fee-for-service payment conflict totally with the incentives under capitation; that under global capitation, the best method for paying primary care physicians is capitation and the best way to pay specialists is discounted fee-for-service; and that small, exclusive physician panels are the most successful for managed care.
Key concepts: Capitation, Managed care, Incentive, Payment, Business, Fee-for-service, Capitation fee, Order (exchange)