Biomaterial Database

The pathologist and managed care. Integration into the new health care delivery system. 1995

S N Bauer

Mercy San Juan Hospital, Carmichael, CA, USA.

As the health care system evolves, managed care plans are expanding rapidly, and pathologists face radical changes in contractual relationships and payment methodology. As a result, entirely new relationships will often need to be negotiated to adapt successfully. The experience of pathologists in areas where there is already high market penetration by managed care plans can be used in strategic planning, learning to gain entry to negotiations, and planning what and how to negotiate. Proper preparation is critical to successful negotiations in our new health care system and requires an understanding of capitation, contracting risks, and opportunities.

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
D010337	Pathology Department, Hospital	Hospital department which administers and provides pathology services.	Hospital Pathology Department,Department, Hospital Pathology,Pathology Departments, Hospital,Departments, Hospital Pathology,Hospital Pathology Departments
D010338	Pathology, Clinical	A subspecialty of pathology applied to the solution of clinical problems, especially the use of laboratory methods in clinical diagnosis. (Dorland, 28th ed.)	Clinical Pathology
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
D003191	Comprehensive Health Care	Providing for the full range of personal health services for diagnosis, treatment, follow-up and rehabilitation of patients.	Comprehensive Healthcare,Health Care, Comprehensive,Healthcare, Comprehensive
D003284	Contract Services	Outside services provided to an institution under a formal financial agreement.	Services, Contract,Contract Service,Service, Contract
D012306	Risk	The probability that an event will occur. It encompasses a variety of measures of the probability of a generally unfavorable outcome.	Relative Risk,Relative Risks,Risk, Relative,Risks,Risks, Relative
D014481	United States	A country in NORTH AMERICA between CANADA and MEXICO.
D017008	Negotiating	The process of bargaining in order to arrive at an agreement or compromise on a matter of importance to the parties involved. It also applies to the hearing and determination of a case by a third party chosen by the parties in controversy, as well as the interposing of a third party to reconcile the parties in controversy.	Arbitrating,Mediating,Arbitration,Conflict Resolution,Mediation,Negotiation,Conflict Resolutions,Negotiations,Resolution, Conflict
D018511	Systems Integration	The procedures involved in combining separately developed modules, components, or subsystems so that they work together as a complete system. (From McGraw-Hill Dictionary of Scientific and Technical Terms, 4th ed)	Integration, Systems,Integrations, Systems,Systems Integrations