This document discusses managed care and performance measurement in healthcare. It provides information on:
- The differences between managed care reimbursement and fee-for-service, including incentives created by capitation payments.
- Examples of managed care review mechanisms like preauthorization, concurrent review, and retrospective review that are intended to reduce unnecessary procedures and hospitalizations.
- Utilization and financial measures used to evaluate providers and health plans, including member months, costs per member per month, and admission rates.
- The similarities and differences between managed care organizations and accountable care organizations, including their reimbursement structures and emphasis on care coordination.