Collaboration in Risk Markets - Collaborative Technologies and Applications for Interactive Information Design - page 193

Figure 3. Collaboration Model for Disease and Demand Management Organizations

in England has shown that the successful design
of financial incentives depends on understand-
ing the complex interplay between central and
local influences. In schemes where collaborative
financing matches service goals with money,
although groups complain they are being held
back by joint restraints, in fact the end result can
be an improvement over traditional financing and
budgeting mechanisms (Wistow, 1990).
Health insurance is based on risk, as insurance
companies charge premiums, which they must
financially solve, for estimated claims. A large
insurance company may have over a billion dollars
of capital invested to improve shareholder value,
ratings, and policy sales. Once risk is acquired,
health insurance companies try to manage it by
contracting with demand and disease management
organizations.
Disease management companies attempt to
determine the best course of treatment for condi-
tions and populations based on outcomes relative
to costs. Demand management is the adjustment
of policyholder health choices and claims toward
the most efficacious paths, presumably to the
benefit of both parties.
Demand and disease management organiza-
tions can collaborate by trading risks. In an ex-
ample scenario, a country adopts a single-payer
system based on taxation and distributes the funds

through insurance companies into a risk pool of
insurance policies, which are required to cover
all people and conditions. Disease and demand
management companies are expert at how to ob-
tain the best outcome at the least cost, and would
collaborate as independent agents. These groups
would have access to an environment that would
allow them to act collaboratively to buy or sell
population or disease risk in a fluid way. This
scheme has the potential to decrease costs and
increase coverage and quality (see Figure 3).

transactions

Risk-based industries such as insurance and fi-
nance require accountability, transparency, and
compliance. These goals require standardized,
universally adopted systems. The current ad-hoc
and patchwork system is not robust enough to
facilitate these types of complex transactions. In
order to develop a unified, consistent, and efficient
system for risk environments, it will be important
to enable sophisticated transactions.
Many risk products are characterized by fea-
tures (such as interest rate) and functional settings
(when to send messages), which require high
levels of openness, adoption, scalability, memory,
integration, efficiency, and standardization of
messaging. A Web Services model is strong in