Penner M
Department of Public Management, University of San Francisco, CA, USA.
Manag Care Q. 1997 Spring;5(2):1-9.
California health maintenance organizations (HMOs) frequently capitate physician organizations--independent practice associations (IPAs) and multispecialty medical groups--to export their risk for professional and outpatient ancillary services. Physician organizations benefit when successful in managing the risk, and from having greater control over medical management decisions. HMOs carefully assess the physician organization's ability to manage capitated risk and provide high-quality care. HMOs gather information on the physician organization's finances, business relationships, physician compensation arrangements, credentialing, hospital relationships, ancillary contracts, procedures for 24-hour care, claims administration, member services, information systems for reporting and tracking utilization, and procedures for utilization/quality management. These data are analyzed to determine whether capitation contract negotiation should proceed.
加利福尼亚的健康维护组织（HMO）常常对医师组织——独立执业协会（IPA）和多专科医疗集团——进行总额支付，以转嫁其在专业医疗服务和门诊辅助服务方面的风险。若能成功管理风险，并对医疗管理决策拥有更大控制权，医师组织就能从中受益。HMO会仔细评估医师组织管理总额支付风险及提供高质量医疗服务的能力。HMO会收集有关医师组织财务状况、商业关系、医师薪酬安排、资格认证、医院关系、辅助服务合同、24小时护理程序、理赔管理、会员服务、用于报告和跟踪医疗服务利用情况的信息系统以及医疗服务利用/质量管理程序等方面的信息。对这些数据进行分析，以确定是否应进行总额支付合同谈判。
