Four authors associated with St. Thomas University, John G. Reiling, M.B.A., John W. LaBree, M.D., Frederick J. "Fritz" Wenzel, FACMPE, and Carl Platou, M.B.A., write about how the changing nature of health care has fostered the need for a specialized Master of Business Administration in Medical Group Management degree program.

Curriculum↗

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Looking to the 90s.

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Administrative Personnel↗

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HMO shakeout.

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Group Practice↗

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A view from under the microscope. Medicare prospective risk contracting.

The authors provide an overview of the Marshfield Clinic's four-year demonstration contract with HCFA that resulted in the enrollment under a prospective risk contract of over 8,900 Medicare beneficiaries. Public policy implications are discussed along with recommendations for group practices contemplating Medicare prospective contracts. Recommendations include the attention which must be paid to potential adverse selection, hospital utilization control, and potential technical and methodological problems with the prospective reimbursement system. Data from the demonstration will be of significant value to other groups interested in prospective contracting with HCFA. The concept of prepaid Medicare, if appropriately refined, can serve the best interests of Medicare beneficiaries, providers, and

Centers for Medicare and Medicaid Services, U.S.↗

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Medicare risk contracts--success or failure?

Recent legislation has led to a new popularity in risk contracting. In 1980 a demonstration was begun by the Health Care Financing Administration that provided input for the current capitation program. Administrators from two groups involved in the demonstration program--the Marshfield Clinic and MedCenters Health Plan--offer the unique perspectives of a medical group practice and a health maintenance organization. Significant issues for any group considering entering a Medicare risk based contract are discussed.

Capitation Fee↗

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Leaders as combat fighter pilots. Research project targets leaders who support money-losing business strategies.

When strategic plans go awry and begin losing money, the smart thing to do is change course. But some leaders get so involved with the plan, they fail to navigate properly and fly right into the target. The organization can lose millions. Examine why this happens and what you can do to prevent it from happening in your organization.

Adaptation, Psychological↗

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Composition of the subscribers in a rural prepair group practice plan.

To determine the degree to which enrollees of the Greater Marshfield Community Health Plan were representative of the community the plan was designed to serve, a telephone survey of 1,838 households in the 30-township area was undertaken. The response rate was 93%, and data were obtained from 1,718 households containing 5,260 persons. Of these, 484 households had at least one health plan member. Since the plan accepts only persons under age 65, analysis of the data was limited to those persons aged 64 and younger. Results indicate that enrollees showed good representation of demographic variables such as age, sex, and relationship to the household head when they were compared to the under 65 population of the area. When the enrollee's socioeconomic characteristics (education, income, and occupation) were studied, it was found that, although enrollees showed good representation for most categories they tended to underrepresent the under 65 area population in the lowest income and education classes, as well as in the semiskilled or unskilled occupations. The opposite was true for the upper income and educational classes. Data on location of residence indicated that a strong relationship existed between enrollment and proximity to Marshfield, where the major health care center is located. The use of health services was found to be positively related to membership, with enrollees overrepresented among those with recent hospital or physician contacts. The ability to obtain coverage through employment or by other means was found not to be related to membership. Satisfaction as expressed by participants was much higher in the prepaid program than among those with other forms of coverage.

Adolescent↗