Embracing the continuum of care: an Australian private hospital's experience.

Continuity of care throughout the home, community, and hospital settings is essential in providing quality health care. A continuum-of-care model assists in improving communication between all stakeholders, decreases confusion, and ensures appropriate provision of resources so that patient/client care needs are met. Historically, continuity of care has been difficult to provide because care delivery has taken place in separate settings. In addition, appropriate processes, incentives and resources have not been in place to ensure sufficient interaction between care providers. In Australia the concept of case management has been inviting because it acknowledges the importance of continuity of care. It also addresses pressures on the health care system to ensure quality, cost-effective service provision. The extent to which continuity of care is provided depends on the flexibility of the case management model including the flexibility of care providers to interact between settings. This article presents an Australian private hospital's experience utilizing a case management model. Three specialties (Home Care, Oncology, and Medical) will be used as examples demonstrating how the model incorporates the continuum of care concept. Their challenges in providing continuity of care beyond the hospital walls are explored.

Controlling disenrollment in health maintenance organizations.

With increasing competition, health maintenance organizations (HMOs) are struggling to maintain their enrollment levels. As a result, growing interest has emerged in studies of disenrollment, including factors associated with disenrollment and its implications for the HMO manager, as well as approaches for measuring and monitoring disenrollment.

Managing liability/recovery programs in health maintenance organizations.

Liability/recovery programs play a major role in attempts by insurers to contain the cost of health care. Because of the controls they have over their organization, HMOs are in an exceptional position to take advantage of the monetary rewards that accompany a liability/recovery program.

The Hospital Capitation Payment Project: new incentives and tools for cost containment.

Blue Cross of North Dakota, Blue Cross of Massachusetts, and the Blue Cross and Blue Shield Association, along with 10 hospitals, developed and implemented the Hospital Capitation Payment Project as a novel approach for containing escalating hospital costs. The hospital is paid a prospective, fixed amount for each person covered; in exchange, it assumes responsibility to provide or pay for all covered services needed by that individual. This responsibility extends to payment for covered care provided by other hospitals. The new tools and incentives created by the program, notably an innovative management information system, are designed to help hospitals better manage the health care needs and related costs of a defined population.

Mandated long-range planning for hospitals--where is it going and why?

Massachusetts has instituted mandated long-range planning for hospitals. The system is helping the state better control program development and hospital costs, and better meet the health needs of Massachusetts residents.