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• W38202487 abstract "Why margins are becoming ??? Do you understand your exposure As in banking, risks can be unbundled The business of healthcare is becoming riskier. Capitation is increasing the providers must assume; expansion of the populations they cover makes health-related events (and the cost) more difficult to predict: and competition among providers is eroding operating margins, making the effect of on profitability more pronounced. At the same time, the management of is becoming more complex as the delivery of healthcare becomes ever more fragmented. Each trend implies a serious threat to healthcare organizations. HMOs for example, face two options for trading off against profitability in the future - they can accept lower margins in the more commodity like low business, or take on higher for potentially higher margins [ILLUSTRATION FOR EXHIBIT 1 OMITTED]. But each also provides opportunities for players who manage risks well and develop a portfolio that suits their appetite for risk, their skills, and customers' needs. This is because healthcare organization margins are actually a risk premium: the reward for taking on risk. To take advantage of the opportunities, must be treated as a core business activity for which responsibility is taken at senior level, rather than as a technical skill to be handled by specialists. As competition and pressure on costs reduce margins, and covered populations become riskier, a more sophisticated approach to management is required. By understanding care provision in terms of as well as average cost, a payor or provider can evaluate all the available management roles and strategies to optimize its performance. The winners will be those that excel at this and integrate management thinking into all aspects of their operating strategy. Principal types of To manage risk, healthcare organizations must first understand the size and characteristics of its four principal types: * Clinical operating - the of variations in the costs incurred by a payor or provider in providing clinical services. * Event - the associated with fluctuating demand for healthcare in the covered population * Pricing - the inherent in setting prices given the unpredictable expenses of event risk. * Financial - the basic business risks faced by all companies: capital, partner insolvency, cash flow, liability, and regulatory risks. The first three are especially important to healthcare organizations, which stand or fall by their ability to manage them. Managing and mitigating financial is also important, but because it is a all businesses face, we will not discuss it further here (Exhibit 2). Event risk. is determined by the characteristics of the pool of covered lives - the members of a healthcare plan or the population managed by a risk-bearing provider - and has two elements: incidence and severity. The greater the variation in occurrence of any one condition among a given population over a year, the higher its incidence risk. Severity is determined by variations in a condition's seriousness and in how much treatment is required. [TABULAR DATA OMITTED] Take asthma. Of any population, the number who will be diagnosed with asthma and who seek treatment will vary. There will also be variations in the amount of treatment each patient requires, depending on the severity and course of the disease. Together, these two variables form the event for asthma for the covered pool of lives. A subset of event is catastrophe risk. Catastrophe is determined by the probability of an abnormally high incidence and/or severity of a given condition, which would result in an extremely high total treatment cost. Because of the remote likelihood of such catastrophes - an epidemic, for example - this is usually managed as a distinct type. …" @default.
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• W38202487 title "Managing Risk in Healthcare" @default.
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