RESUMO

The Medicare population remains largely unmanaged despite its increasing cost burden. With a few notable exceptions, health maintenance organizations (HMOs) have historically avoided serving this expensive segment. In many cases, the inability to control costs results from failing to understand the importance of specialist reimbursement mechanisms. This article examines the importance of these mechanisms and describes how to successfully capitate specialty physicians in a Medicare risk program. The article also includes a case study on a successful capitation agreement between an HMO and a specialty group.

Assuntos

Economia Médica , Sistemas Pré-Pagos de Saúde/economia , Medicare Part B/organização & administração , Especialização , Idoso , Capitação , Serviços Contratados/economia , Humanos , Medicare Part B/economia , New Mexico , Métodos de Controle de Pagamentos , Mecanismo de Reembolso/economia , Estados Unidos