Managed Care Risk Contracting

Summary

This practice note covers risk contracts between managed care organizations and their participating providers. With the advent of sophisticated utilization review, management information systems, and clinical pathways, providers believe that they are in a better position to manage the intensity of utilization and therefore benefit the most from risk contracts. However, risk contracts require close analysis of the methodologies that will be employed in order to understand the financial risks that providers take on when entering into the agreements.