ABSTRACT
In a healthcare environment that changes daily, healthcare providers are increasingly exposed to the financial risks associated with providing medical care. As physicians are probably aware, many medical providers have reimbursement contracts with Managed Care Organizations based upon capitation. A majority of healthcare costs stems from a small number of catastrophic cases such as the previous example. In a capitated environment, these cases critically threaten a provider financially. To protect themselves against large potential losses, healthcare providers need comprehensive insurance that is both flexible with and responsive to their unique needs. Managed care, disease management, consumer-driven healthcare, and other types of medical risk management initiatives have altered traditional products and portfolios. When seeking reinsurance coverage for an integrated health delivery system or provider organization, there are several things to consider: primarily, cost and coverage. Realize that physicians are going to an outside insurer and they can design any level of reimbursement, within reason, and any deductible.
