Is a financial arrangement between the HMO and its providers whereby the provider shares some of the loss if an HMO’s utilization or medical costs cause an unexpected operational deficit. The provider also shares in the profits.
The distribution of financial risk among parties furnishing a service. For example, if a hospital and a group of physicians from a corporation provide health care at a fixed price, a risk-sharing arrangement would entail both the hospital and the group being held liable if expenses exceed revenues. A method by which medical insurance premiums are shared by plan sponsors and participants. In contrast to traditional indemnity plans in which insurance premiums belonged solely to insurance company that assumed all risk of using these premiums. Key to this approach is that the premiums are only payment providers receive; provides powerful incentive to be parsimonious with care.
A method by which the risk of inaccurate rate adjustment is shared by plan sponsors and purchasers, typically managed care organizations and states. In contrast to traditional indemnity plans, in which insurance premiums belong solely to the insurance company that assumes all risk of providing the care paid for by these premiums.
Arrangements made between Medicaid programs and health plans to share the risk of losses or benefits of profits to protect both sides from losses that result from inaccurate risk adjustment. As an example, a health plan may contract with the Medicaid program to be responsible for 90 percent of the first five percent margin (profit or loss) for the year; for the next ten percent of margin, the state and plan split the margin 50-50; and for profits and losses greater than 15 percent of the capitation, the state assumes 90 percent of the risk.
A variation of risk-transfer systems in which losses and profits are shared between two or more parties (e.g., between the purchaser and the managed care organization) in a contractually defined manner, rather than being assumed by one entity alone; this method spreads the risk of unplanned, unexpected financial loss resulting from underestimations of service needs.
Apportionment of chance of incurring financial loss by an insurers, managed care organizations, and health care providers.
diminution of a risk by sharing it with others, usually for some consideration.
Sharing with another party the burden of loss, or benefit of gain from a particular risk... AS/NZS 4360 Risk Management...
Situation in which the managed care entity assumes responsibility for services for a specific group but is protected against unexpected high costs by a pre-arranged agreement for higher payments for those individuals who need significantly more costly services. Risk is usually shared by the managed care entity and the state.
A financial arrangement between health care providers, managed care organizations and another entity such as a state Medicaid program in order to spread the risk of providing health care services. This type of arrangement is often employed to protect providers and managed care organizations serving chronically ill individuals (such as people living with HIV) from financial insolvency.