Payment by Capitation and the Quality of Care

Berwick, Donald M.

doi:10.1056/nejm199610173351611

Cited by 132 publications

(57 citation statements)

References 29 publications

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“…Berwick (1996) In support of this theory Murray, Greenfield, Kaplan and Yano (1992), conducted a study dealing specifically with blood pressure control. They detailed the impact of varying reimbursement incentives, to include capitation, on physician behavior and the simultaneous implications for patients' health outcomes.…”

Section: Literature Reviewmentioning

confidence: 96%

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Management Strategies to Ensure Successful Adaptation to Enrollment Based Capitation Budgeting Methodology at Mach

Swingle¹

1998

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IOT3 qu&HTT jsmmmD 4 REPORT DOCUMENTATION PAGEForm Approved OMB No. 0704-0188 fttfc^plEHogliurdtn for this collection of information is estimated to average 1 hour per response, including the tine for reviewing instructions, seerching existing dsta sources, gathering and maintaining the data needed, and completing end reviewing the collection of information. Send comments regerding this burden estimate or any other aspect of this ' collection of information, including suggestions for reducing this burden, to Wsshington Headquarters Services, Directorete The objective of this research project is to explore the various management strategies that may be implemented to facilitate the transition to an Enrollment Based Capitation (EBC) budgeting methodology at Moncrief Army Community Hospital (MACH) Fort Jackson, South Carolina. The methodology used for this project was to review a variety of the significant systems and practices currently being employed at MACH, predict the impact of these systems during the transition to EBC, and recommend any appropriate modifications to facilitate the transition to EBC.This project addresses the current historical based budgeting process and contrasts it to the Enrollment Based Capitation budget process proposed by the Department of Defense Health Program. This comparison was made to demonstrated those practices under historical based budgeting that will adversely effect the outcomes of EBC. The significant management strategies are derived from various programs currently in place at MACH.The results of the project are recommendations for the MACH to consider in order to ensure success during the turbulent transition period. The recommendations are correlated to marketing, the importance of information systems, utilization management, reorganization, accuracy of data input, and efficiency of services provided. 11Abstract A significant portion of the managed care health care industry is currently undergoing a momentous transition from the traditional fee-for-service payment methodology to a capitated type of reimbursement system. The military, being one of the largest providers of health care in the country, is also participating in this transition.The objective of this research project is to explore the various management strategies that may be implemented to facilitate the transition to an Enrollment Based Capitation (EBC) budgeting methodology at Moncrief Army Community Hospital (MACH) Fort Jackson, South Carolina. The methodology used for this project was to review a variety of the significant systems and practices currently being employed at MACH, predict the impact of these systems during the transition to EBC, and recommend any appropriate modifications to facilitate the transition to EBC.This project addresses the current historical based budgeting process and contrasts it to the Enrollment Based Capitation budget process proposed by the Department of Defense Health Program.This comparison was made to demonstrated those practices under historical based budgeting that will ...

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Section: Literature Reviewmentioning

confidence: 96%

“…Because Fort Jackson is principally a basic training post there is primarily a need for primary care providers at MACH. In most managed care systems, specialists have not yet been asked to accept capitation (Berwick, 1996). The specialists are still generally paid on the basis of some form of FFS system.…”

Section: Management Strategies 11mentioning

confidence: 99%

Management Strategies to Ensure Successful Adaptation to Enrollment Based Capitation Budgeting Methodology at Mach

Swingle¹

1998

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“…5 Efficiencies in practice styles require an organizational infrastructure that bridges the traditional chasm between clinical and administrative services. 6 This infrastructure comprises medical directors, utilization management committees, utilization review nurses, and case managers for chronically ill patients. and organizational culture of the physician system.…”

Section: The Need For Capitalmentioning

confidence: 99%

Financial Capital And Intellectual Capital In Physician Practice Management

Robinson¹

1998

Health Affairs

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“…Empirical evidence supports the general view that health maintenance organizations (HMOs) reduce the cost of care while sometimes improving quality, or at least without reducing the quality of processes and outcomes. 1 But beyond this, it is difficult to make a case for one or another type of organization, or for the importance for quality of one or another organizational feature. One is forced to rely on informed judgment, common sense, and theory.…”

mentioning

confidence: 99%

“…Berwick rightly points out that capitation creates an incentive to reorient one's thinking from producing and selling separate services to creating an integrated approach to care. 10 Integrating the financing of care through capitation sharpens the incentive to integrate the design and provision of care and encourages innovation. Therefore, when a new idea creates a need for resources in one department but a savings in another department, the whole system can benefit from the idea by rearranging costs internally while encouraging the innovation.…”

mentioning

confidence: 99%

A Vision Of Quality In Health Care Delivery

Enthoven¹,

C²

1997

Health Affairs

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PROLOGUE:In 1991 Avedis Donabedian wrote that "a health care system reflects the values adopted by a society and the ways in which it has chosen to conduct its affairs." Changes in the U.S. health care system in this decade have been testimony to these words, with government efforts giving way to the marketplace as the chief driver of reform. Now, with health plans at center stage, policymakers are turning their attention to the concern underlying Donabedian's statement-society's commitment to high-quality health care. In the managed care environment, the challenge of measuring and ensuring quality has taken on new significance, as health plans compete for market share and consumers and purchasers adjust to their new role in scrutinizing plan performance.In this essay, Alain Enthoven and Carol Vorhaus respond to the question: What would a high-quality health care delivery system look like? They identify practices and institutions that integrate or exemplify quality assessment and improvement, and they look at features of the managed care system that help create a quality-oriented health care infrastructure.Alain Enthoven is Marriner S. Eccles Professor of Public and Private Management in the Graduate School of Business at Stanford University. Carol Vorhaus is a research associate there. Enthoven has been a long-time participant in the Jackson Hole Group, a group of private-and public-sector figures that promoted managed competition as the most appropriate prescription for reforming the U.S. health care system. He also has influenced the direction of health care reform in several other countries (England and the Netherlands) that have embraced elements of the marketplace model.

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Payment by Capitation and the Quality of Care

Cited by 132 publications

References 29 publications

Management Strategies to Ensure Successful Adaptation to Enrollment Based Capitation Budgeting Methodology at Mach

Management Strategies to Ensure Successful Adaptation to Enrollment Based Capitation Budgeting Methodology at Mach

Financial Capital And Intellectual Capital In Physician Practice Management

A Vision Of Quality In Health Care Delivery

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