The Capitation Sourcebook: A Practical Guide to Managing At-Risk Arrangements

Editor: Peter Borland

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The Capitation Sourcebook: A Practical Guide to Managing At-Risk Arrangements

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This book weaves together the insights of 40 experts on payment methods. Its 30 chapters illustrate how successful health care organizations have developed effective tools and financial incentives that link physician practice with clinical performance. The book catalogues hundreds of ways providers are using capitation to change practice patterns and meet the needs of purchasers and patients for better care.

664 Pages © 1996

Table of Contents

Part One
Introduction

Chapter 1
The Power and Potential of Capitation

Chapter 2
Components of a Vertically Integrated System

Chapter 3
Performance Metrics and Capitation Strategies

Chapter 4
Physician Autonomy and Provider Accountability

Part Two
Physician Incentives and Compensation Design

Chapter 5
Distribution of Capitation with Physician Organizations

Chapter 6
Refining Reimbursement Methods for Physician Services

Chapter 7
Balancing Physician Financial and Nonfinancial Incentives

Chapter 8
Aligning Performance and Payment Criteria

Part Three
Transition Management Techniques

Chapter 9
Managing the Transition from Fee for Service to Prepaid Incentives

Chapter 10
Physician Compensation Models for Phasing to Capitation

Chapter 11
Staging the Transition to Capitated Medical Groups

Chapter 12
Developing a Global Capitation Model for an Integrated Delivery Network

Chapter 13
Budgeted Capitation as a Transition Model

Chapter 14
Medicaid Capitation and Information Management

Chapter 15
Case Study: Capitation, Collaboration, and Economic Darwinism

Part Four
Network Financial Management

Chapter 16
Financial Controls and Reporting for Capitation

Chapter 17
Special Issues of Ambulatory Capitation

Part Five
Resource Management

Chapter 18
Measuring Hospital Resource Consumption

Chapter 19
Managing Hospital Capitation

Chapter 20
Clinic-Based Utilization Management

Chapter 21
Developing and Implementing Care Management Programs

Part Six
Contract Negotiation Principles

Chapter 22
Using Actuarial Cost Models to Evaluate Contracts

Chapter 23
Risk-Adjusted Capitation

Chapter 24
Minimizing Employer Liability in Managed Care Arrangements

Part Seven
Specialty and Ancillary Services Contracting

Chapter 25
Guidelines for subcontracting with Specialty Providers

Chapter 26
Behavioral Health Capitation

Chapter 27
Ancillary Medical Service Strategies

Chapter 28
Capitated Pharmaceutical Pricing

Part Eight
Epilogue

Chapter 29
Ethical Issues in Risk-Based Contracting

Chapter 30
Economic Incentives to Do Harm or Good