A MODEL TO MANAGE CAPITATED RISK

The impact of increasing enrollment in Medicare HMOs will require heal th care providers to develop new strategies in care delivery systems. Key strategies in managing risk include health risk appraisals, proact ive case management, disease management, provider education, and the u se of inpatient physician managers. Implementing an integrated care ma nagement system requires a team approach. The physician inpatient mana ger, nurse case manager, geriatric clinical nurse specialist, and soci al worker composed the health care team charged with implementing a ca re management system responsive to enrollees' needs. A quality managem ent plan is essential for tracking patient outcomes and quality indica tors across the continuum. The focus of promoting wellness and prevent ing illness represents a paradigm shift from the traditional model of episodic care that can yield positive financial results.