... can benefit the provider due to increased visits by an insured. The provider can be rewarded by excessive utilization of medical services. Concerning FFS plans, the employee, employer, insured, and provider share the cost of medical care. The goal is to reward providers who deliver quality, cost-effective care. Capitation is the payment for services based on the number of patients covered for specific services; the provider is compensated per person, per capita, not per service. The provider is paid the same monthly amount regardless how often the member receives care. The goal is to serve a high volume of members, keep them healthy, and to treat illnesses promptly. As managed care, integrated systems, and integrated delivery networks become more the norm than the exception, there will be a continuing increase in the need to understand just how these structures operate, what it takes to ensure their operational and financial viability, ...

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