When capitation's hold weakens











Say what you will about capitation (and a lot has been said), it did help to put the brakes on costs in the 1990s. Now, according to the Segal Co., the West may well experience higher claims thanks to "the erosion of prepaid ... arrangements ... (which was the predominant method of reimbursement for many provider groups in the West)."

Other causes include "negotiation of significant increases in reimbursement by hospital and physician systems, price concessions made in previous years, and liberalization of plan rules for participants, such as open-access arrangements and elimination of precertification rules."

Segal defines a cost trend as the average forecasted change in health plans' per-capita claims cost. "It is important to note that although there is usually a high correlation between trend and plan sponsors' actual cost increases, trend and net change in year-to-year plan costs are not the same," the authors write.


Career Opportunities

HAP, a subsidiary of Henry Ford Health System, is a nonprofit health plan providing coverage to individuals, companies and organizations. This executive develops strategies to meet membership and revenue targets through products, pricing, market segmentation and advertising.  Aligns business among Business Development, Commercial Sales, Medicare and Public Sector Programs and Product Development. Seeks to enhance and be responsible for business development and expansion through the development of an effective product portfolio, strong interpersonal relationships and service excellence.

Apply via email to jfedder1@hfhs.org or online at http://p.rfer.us/HENRYFORDlXqAJA

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