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Full-Text Articles in Medicine and Health Sciences
Successful Allocation Of Funds In Managed Health Care Programs Revenue, Sherri Jean Loveall
Successful Allocation Of Funds In Managed Health Care Programs Revenue, Sherri Jean Loveall
Walden Dissertations and Doctoral Studies
Managed care leaders of independent physician associations (IPAs) lack strategies for allocating existing funds to avoid business closure. Medical providers are concerned with the quality of care for patients if the allocation of funding is not executed correctly. Grounded in the competing values framework (CVF), the purpose of this qualitative single case study was to explore strategies managed care leaders of IPAs use to allocate funds to avoid business closure. Participants were six executive leaders of an IPA in Los Angeles, the United States, who successfully managed the allocation of funds in a managed healthcare system. Data were collected from …
Profitably Risky: A Study Of Medicare Capitation Contracts For Primary Care Medical Practices, Michael Wieck
Profitably Risky: A Study Of Medicare Capitation Contracts For Primary Care Medical Practices, Michael Wieck
Dissertations
The Centers for Medicare and Medicaid Services is seeking to move medical providers from a fee-for-service reimbursement model to a value-based reimbursement model. In this dissertation, we studied the financial rewards and risks that accompany capitation contracts. We employed Poisson regression to estimate health-care utilization of beneficiaries under the care of primary care providers with varying levels of capitation. Then, we calculated capitation contract results for primary care practices using Monte Carlo simulations. We used three methods to predict medical payments for beneficiaries: (1) empirical probability distributions of annual medical payments, (2) theoretical probability distributions of annual medical payments, and …