Hospital Risk Pool Funds from hospital risk pools established by managed care companies will be part of the overall funds flow. The distribution formula for the risk pool fund will be determined by the UPMG Management Committee, based upon analysis of each contract. This risk pool is established to ensure that primary care clinicians have appropriately referred or have not over referred or under referred to specialists and ancillary services. Funding of this pool is from a portion of the primary care capitation. Returned patient statistics.
Appropriate utilization results in the total pool distributed to primary care.
A specialist risk pool will be established to ensure that specialists have appropriately referred or have not over referred or under referred to other specialists or for ancillary services. Returned patient statistics. Appropriate utilization results in funds reallocated to contributing specialists or to ancillary departments. Inappropriate utilization results in all or part of the pool distributed to affected specialists or ancillary departments. Medical legal consultation.