Introduction – Risk sharing contracts are the agreements between any two groups that helps to identify and face the risks and benefits of the health care providing process. These contracts can take place between individual private practitioners and patients or among physician’s and hospital organization or physicians and insurers or among insurers and patients or among insurers and hospital institutions. (1)This contracts provides an ample scope to equally distribute the loss or gain during health care practice even in the occurrence of adverse event or abnormal service.
Uses of these contracts-
1) Both parties can better understand the actual process and help to bring them on the same page about what they are expecting.
2) Manage the ever …show more content…
Strategies to strengthen risk contracts between physicians and patients (2)-
1) Narrow down the hospitals and opted products-
Always try to concise the hospital network available to patients i.e. patients have to choose their primary care provider based on their illness. Make sure to broaden the primary care providers list ranging from gynecologists, endocrinologists, general physicians, rheumatologists, urgent care centers etc. Allocate financial incentives and structures minimal copay for mobilizing the patients to use primary care providers rather than high end care. Restrict the choice of opting costly diagnostic procedures like MRI scan, PET scan etc or usage of high cost pharmaceutical products like high end antibiotics etc.
• Uses- This strategy is helpful for HMO (health maintenance organization) or hospitals having a chain of network or in PPO (preferred provider organization) to encourage patients to stay in network.
2) Organize the customized pricing …show more content…
If there is raise in risk then try to negotiate with patient about changes in financial incentives.
• This strategy better works for a health care institution to attract new patients and to retain their old patients.
3) Negotiate to improve claims frequency feed-
Creating a single portal to view all claims from payers and encourage to receive claims at least monthly.
• This strategy best suits for insurance organization.
4) Standardize quality measures-
Make sure to imbibe the quality measures suggested by CMS (center for Medicare and Medicaid services). Pick the quality measures that an organization infrastructure can surely support it with minimal risk. Set a target of at least six quality metrics are accommodated.
• Useful for health care organization to bind to the quality measures set by health department.
5) Setting Upfront financing-
Allotting incentives to the institutions that meet the goals.
Various risk sharing methods in current usage
1) Fee for service (FFS)-
In this widely used traditional payment system payment to the physician or hospital is done by patient or by reimbursement method from insurer
Uses of these contracts-
1) Both parties can better understand the actual process and help to bring them on the same page about what they are expecting.
2) Manage the ever …show more content…
Strategies to strengthen risk contracts between physicians and patients (2)-
1) Narrow down the hospitals and opted products-
Always try to concise the hospital network available to patients i.e. patients have to choose their primary care provider based on their illness. Make sure to broaden the primary care providers list ranging from gynecologists, endocrinologists, general physicians, rheumatologists, urgent care centers etc. Allocate financial incentives and structures minimal copay for mobilizing the patients to use primary care providers rather than high end care. Restrict the choice of opting costly diagnostic procedures like MRI scan, PET scan etc or usage of high cost pharmaceutical products like high end antibiotics etc.
• Uses- This strategy is helpful for HMO (health maintenance organization) or hospitals having a chain of network or in PPO (preferred provider organization) to encourage patients to stay in network.
2) Organize the customized pricing …show more content…
If there is raise in risk then try to negotiate with patient about changes in financial incentives.
• This strategy better works for a health care institution to attract new patients and to retain their old patients.
3) Negotiate to improve claims frequency feed-
Creating a single portal to view all claims from payers and encourage to receive claims at least monthly.
• This strategy best suits for insurance organization.
4) Standardize quality measures-
Make sure to imbibe the quality measures suggested by CMS (center for Medicare and Medicaid services). Pick the quality measures that an organization infrastructure can surely support it with minimal risk. Set a target of at least six quality metrics are accommodated.
• Useful for health care organization to bind to the quality measures set by health department.
5) Setting Upfront financing-
Allotting incentives to the institutions that meet the goals.
Various risk sharing methods in current usage
1) Fee for service (FFS)-
In this widely used traditional payment system payment to the physician or hospital is done by patient or by reimbursement method from insurer