Organized healthcare arrangements
Compliance Monitor, April 8, 2005
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Q. What is an organized healthcare arrangement (OHCA)?
A. An OHCA is an arrangement of covered providers that includes the following integrated care delivery and payment options:
- A clinically integrated care setting in which individuals typically receive healthcare from more than one provider
- An organized system of healthcare in which more than one CE participates and in which the participants present themselves to the public as part of a joint arrangement
In a system where more than one CE participates, the CEs must work together on at least one of the following:
- Utilization review
- Quality assessment and improvement activities
- Payment activities, if the OHCA participants share the financial risk for delivering healthcare
To qualify as an OHCA, healthcare providers must present themselves as a clinically integrated joint arrangement and must have joint utilization review or quality assurance and share financial risk.
Editor's note: Attorney Bill Roach of McDermott Will & Emery in Chicago answered this question. This is not legal advice. Consult your attorney for legal matters.
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