Capitation survival kit: How to fashion provider excess coverage
✍ Scribed by Lee Paige; Ethan Crain; James Bollman
- Publisher
- Wiley (John Wiley & Sons)
- Year
- 1997
- Tongue
- English
- Weight
- 486 KB
- Volume
- 17
- Category
- Article
- ISSN
- 1074-4797
No coin nor oath required. For personal study only.
✦ Synopsis
Mega MCO, Inc., a managed care organization, planned to enter into a fully capitated contract with only one of the two hospitals in Paradigm City. Eastside Memorial and Westside General, furious competitors, were vying for the contract.
Eastside's chief financial officer (CFO) and director of managed care "won" the race by being the first to submit the signed agreement to MCO. The CFO then directed the hospital risk manager to work with Eastside's insurance agent to "cover our financial risk of this contract." The agent, who had not placed provider excess insurance before, nevertheless managed to get four competing quotes with per-member per-month (PMPM) rates ranging from a low of $1.95 to a high of $10.82. The agent and the risk manager struggled through analysis of the quotations and ultimately selected an