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Ambulatory care groupings : When, how, and the impact on managed care

Ambulatory care groupings : When, how, and the impact on managed care

Authors :
Scott B. Clay
Deborah S. Kolb
Source :
Journal of Ambulatory Care Management. 17:29-38
Publication Year :
1994
Publisher :
Ovid Technologies (Wolters Kluwer Health), 1994.

Abstract

This article explores case-mix adjustment systems in the ambulatory care environment as applied by managed care firms. An overview of ambulatory care groupings or ambulatory case-mix systems is given, and the special case-mix adjustment needs of managed care companies are reviewed. Generally, two types of ambulatory care grouping systems are available: encounter-based and population-based. Case examples of three managed care companies that are currently investigating the use of population-based case-mix systems are used to demonstrate the possible use of such systems in the managed care environment such as physician profiling and capitation rate setting.

Details

ISSN :
01489917
Volume :
17
Database :
OpenAIRE
Journal :
Journal of Ambulatory Care Management
Accession number :
edsair.doi.dedup.....0ffef4b2e48d79771089167c32075eb8
Full Text :
https://doi.org/10.1097/00004479-199401000-00006