Biomaterial Database

Information management for managed care. 1995

K O'Connor

Contultants Medical Group Inc., Oakland, CA 94609, USA.

A key concern for medical groups is how to manage information in a dual environment of capitation and fee for service. Information systems that work for one may not work for the other. Finding a system that works for both is critical. Some of the data that would be beneficial to collect for starting managing capitation contracts include: age/sex ratios of the practice patient population, average number of visits per patient per year, average number of visits by ICD-9 code for total population, average procedures per patient per year, and analysis of paverage payment per visit/procedure for commercial and Medicare patients. Some of the major concerns addressed include operational issues, financial viability and automated billing systems.

UI	MeSH Term	Description	Entries
D008329	Managed Care Programs	Health insurance plans intended to reduce unnecessary health care costs through a variety of mechanisms, including: economic incentives for physicians and patients to select less costly forms of care; programs for reviewing the medical necessity of specific services; increased beneficiary cost sharing; controls on inpatient admissions and lengths of stay; the establishment of cost-sharing incentives for outpatient surgery; selective contracting with health care providers; and the intensive management of high-cost health care cases. The programs may be provided in a variety of settings, such as HEALTH MAINTENANCE ORGANIZATIONS and PREFERRED PROVIDER ORGANIZATIONS.	Case Management, Insurance,Insurance Case Management,Managed Health Care Insurance Plans,Managed Care,Care, Managed,Managed Care Program,Management, Insurance Case,Program, Managed Care,Programs, Managed Care
D008331	Management Information Systems	Systems designed to provide information primarily concerned with the administrative functions associated with the provision and utilization of services; also includes program planning, etc.	Information System, Management,Information Systems, Management,Management Information System,System, Management Information,Systems, Management Information
D011216	Practice Management, Medical	The organization and operation of the business aspects of a physician's practice.	Medical Practice Management Services,Management, Medical Practice,Medical Practice Management,Practice Management Services, Medical,Managements, Medical Practice,Medical Practice Managements,Practice Managements, Medical
D002204	Capitation Fee	A method of payment for health services in which an individual or institutional provider is paid a fixed, per capita amount without regard to the actual number or nature of services provided to each patient.	Fee, Capitation,Capitation Fees,Fees, Capitation
D003625	Data Collection	Systematic gathering of data for a particular purpose from various sources, including questionnaires, interviews, observation, existing records, and electronic devices. The process is usually preliminary to statistical analysis of the data.	Data Collection Methods,Dual Data Collection,Collection Method, Data,Collection Methods, Data,Collection, Data,Collection, Dual Data,Data Collection Method,Method, Data Collection,Methods, Data Collection
D006123	Group Practice	Any group of three or more full-time physicians organized in a legally recognized entity for the provision of health care services, sharing space, equipment, personnel and records for both patient care and business management, and who have a predetermined arrangement for the distribution of income.	Group Practices,Practice, Group,Practices, Group
D014481	United States	A country in NORTH AMERICA between CANADA and MEXICO.
D014600	Utilization Review	An organized procedure carried out through committees to review admissions, duration of stay, professional services furnished, and to evaluate the medical necessity of those services and promote their most efficient use.	Review, Utilization,Reviews, Utilization,Utilization Reviews
D016347	Medical Records Systems, Computerized	Computer-based systems for input, storage, display, retrieval, and printing of information contained in a patient's medical record.	Automated Medical Records Systems,Computerized Medical Records Systems,Automated Medical Record System,Automated Medical Record Systems,Automated Medical Records System,Computerized Medical Record System,Computerized Medical Record Systems,Computerized Medical Records System,Computerized Patient Medical Records,Medical Record System, Automated,Medical Record System, Computerized,Medical Record Systems, Automated,Medical Record Systems, Computerized,Medical Records System, Automated,Medical Records System, Computerized,Medical Records Systems, Automated
D018588	Fee-for-Service Plans	Method of charging whereby a physician or other practitioner bills for each encounter or service rendered. In addition to physicians, other health care professionals are reimbursed via this mechanism. Fee-for-service plans contrast with salary, per capita, and prepayment systems, where the payment does not change with the number of services actually used or if none are used. (From Discursive Dictionary of Health Care, 1976)	Fee-for-Service, Medical,Reimbursement, Fee-for-Service,Fee for Service,Fees for Service,Fee for Service Plans,Fee for Service, Medical,Fee for Services,Fee-for-Service Plan,Fee-for-Service Reimbursement,Fee-for-Service Reimbursements,Fee-for-Services, Medical,Fees for Services,Medical Fee-for-Service,Medical Fee-for-Services,Plan, Fee-for-Service,Plans, Fee-for-Service,Reimbursement, Fee for Service,Reimbursements, Fee-for-Service,Service, Fee for,Service, Fees for,Services, Fee for,Services, Fees for