Managing Risk: A Leader's Guide to Creating a Successful Managed Care Provider Organization (J-B AHA Press)

Providers who ignore the fundamentals of risk management may be placing their organizations in peril. This book helps leaders of such organizations to develop systems that succeed in controlling managed care risk.

Hospitals, physicians, integrated deliver systems (IDSs), and other providers that deliver care face unique challenges of risk that differ from those of most insurers and HMOs. Managing Risk addresses risk issues concerning these diverse provider groups and discusses:

• Quantifying risks of capitation and other managed care arrangements
• Using a funds flow model to spread risk
• How provider information systems (ISs) relate to an organization's ability to manage financial risk.
• Operational and clinical approaches to managing risk
• Financial incentive programs for physicians
• PSOs and the future of health care risk

BRUCE S. PYENSON, FSA, MAAA, is a consulting actuary in Milliman & Robertson's New York City office. Mr. Pyenson has consulted to a wide variety of providers, medical suppliers, HMOs, and insurers on issues ranging from capitation development to strategic planning. Mr. Pyenson served as the editor for this book's predecessor, Calculated Risk (AHA Press, 1995). MILLIMAN & ROBERTSON, INC. is an international firm of consultants and actuaries with offices in major cities throughout the United States. With almost 1,000 employees, M & R uses actuarial risk management expertise to provide strategic and tactical advice to a full range of financial and health care organizations, providers, governments, and employers. The firm has helped many HMOs, insurance companies, Blue Cross/Blue Shield Plans, and providers measure their financial status, appraise business opportunities, develop new products, and determine premium rates.