Pearce J W, Benoff M
Dan Grauman Associates, Inc., Bala Cynwyd, PA, USA.
Healthc Financ Manage. 1999 Jan;53(1):31-5.
To understand the causes of financial losses associated with risk arrangements, and eliminate those deficits, integrated delivery systems (IDSs) need to be able to perform detailed analyses on all aspects of their utilization data. Evaluations of utilization should begin with a traditional variance analysis to pinpoint areas where costs are higher than anticipated. Then, a series of increasingly specific analyses should be performed on utilization data within those areas. Often, losses may be attributable to the inability of primary care physicians to serve as effective patient care managers. IDSs, therefore, should compare the practices of their primary care physicians and share results in a way that highlights each physician's performance while ensuring physician anonymity. IDSs should take steps to reduce future losses by providing physicians and utilization management staff with information that will help them control costs, developing a performance-improvement plan for primary care physicians, and implementing payment incentives for physicians.
为了理解与风险安排相关的财务损失的原因，并消除这些亏空，整合式医疗服务体系（IDSs）需要能够对其利用数据的各个方面进行详细分析。利用情况评估应从传统的差异分析开始，以确定成本高于预期的领域。然后，应对这些领域内的利用数据进行一系列越来越具体的分析。通常，损失可能归因于初级保健医生无法有效地担任患者护理管理者。因此，整合式医疗服务体系应比较其初级保健医生的做法，并以突出每位医生的表现同时确保医生匿名的方式分享结果。整合式医疗服务体系应采取措施减少未来的损失，为医生和利用管理工作人员提供有助于他们控制成本的信息，为初级保健医生制定绩效改进计划，并对医生实施支付激励措施。
