Vol. 6, No. 11 November 1997

A SPECIAL SECTION–CAPITATION: STATE OF THE ART

The March of Capitation: Reversed or Just Delayed?  29

Confounding the predictions of many an expert, per-member, per-month prepayment of physicians is not sweeping the nation. The reality has turned out to be more complex than the prophecy.

‘Contact Capitation’ And Its Cousins  36

Between fee-for-service payment and pure capitation, health plans are developing several alternative means of paying specialists. So-called “contact capitation” is one of them.

The Future of Capitation In a World of Shared Risk   43

Will global capitation be the means of reducing HMOs to the status of third-party administrators? Experts differ on that one. But they agree that capitation, in its various forms, is here to stay.

THE OREGON EXPERIENCE

Must Doctors Lose Money With Managed Medicaid?  45

It didn’t take a seer to predict that states would try managed care, but only a seer today can be sure whether doctors will be able to live with Medicaid risk contracts. Oregon’s example is instructive.

NCQA’s Quality Compass Points to Plan Differences  52A

A report on how health plans compare on HEDIS standards provides a starting point for assessing plan quality–and raises eyebrows. Some say one shouldn’t read too much into the numbers.

An Interview With Paul Ellwood Jr., M.D.: Renewed Hope for Quality Competition  53

History has vindicated Paul Ellwood’s prediction of a price- competitive market. Is the inventor of the term HMO right again in saying today’s trend away from integration will be reversed?

SPECIAL SUPPLEMENT

Roundtable Discussion on Medicare’s Slow Transition to Managed Care  69

Zeneca Pharmaceuticals brought five experts together to discuss Medicare’s transformation into a flexible, multi-option system. Their comments suggest Medicare’s toughest days are still ahead.

Tough Road Ahead for the AMA’s Physician Accreditation Program  80

Way back when, credentialing was something done only by hospitals. Now, nearly every health plan checks on every physician. Can the AMA’s new program help do the job?

 

DEPARTMENTS

Editor’s Memo  6
News and Commentary  8
Washington Initiatives  12
Compensation Monitor  18
State Initiatives  23
Employer Update  25
Ethics  85
Legal Forum  87
Managed Care Outlook  90


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