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Managed Care January 2004 Martin Sipkoff	Transparency Called Key To Uniting Cost Control, Quality Improvement NCQA President Margaret O'Kane and a panel of clinically oriented administrators call for emphasis on making the best care financially attractive to physicians, plans, and employers.
Managed Care May 2007 MargaretAnn Cross	Following the Leaders Top pay-for-performance programs point to increased focus on hospital incentives, efficiency measures, coordination, and standardization.
Managed Care June 2005 Martin Sipkoff	The Re-Emergence of the Primary Care Physician A new model of care developed by the American Academy of Family Physicians places primary care physicians back at the center of care delivery.
Managed Care November 2003 Martin Sipkoff	9 Ways To Reduce Unwarranted Variation Unwarranted variation in medical practice is costly -- and deadly. When the approach in one town is major surgery and in another, it's watchful waiting, you know there's a problem.
Managed Care May 2006 Martin Sipkoff	Health Plans Are Ill-Prepared for Looming Diabetes Epidemic The problem is outpacing insurers' resources and perhaps even their commitment. Can the chronic care model help?
Managed Care June 2001 Frank Diamond	HMO/Physician Strain Creates Invisible Costs Perhaps goodwill is too much to ask for. However, peaceful coexistence can certainly help all players reach their mutual goal -- a smooth relationship that helps to get the job done...
Managed Care February 2005 Tony Berberabe	Information: It's Better When You Share Today's version of a community health information network, the regional health information organization, is a collaborative of health plans, health care providers, and hospitals in a given geographic area that collects patient information stored on a secure Web site.
Managed Care January 2005 Alice G. Gosfield	P4P: Transitional at Best Pay-for-performance (P4P) programs promise a fair shake for provider and insurance plan, but a former chairman of the National Committee for Quality Assurance sees many design flaws to overcome.
Managed Care April 2004 MargaretAnn Cross	Medical Directors Find Themselves Working More Closely With Payers As large companies become more demanding of health plans, clinical executives are increasingly being relied on to provide advice and expertise.
Managed Care May 2003 MargaretAnn Cross	Physicians in Large Corporations Take on More Influential Roles Businesses are relying on doctors to direct the health benefit. They often work directly with plans to keep workers healthy -- and at their posts.
Managed Care May 2004 Martin Sipkoff	Will Pay for Performance Programs Introduce a New Set of Problems? Paying incentives to physicians to practice evidence-based medicine appears to be an idea whose time has come. Such programs -- even if successful -- may create a new set of problems.
Managed Care December 2002 MargaretAnn Cross	Advisory Boards Create Company-Plan Cooperation Very effective if used properly, these panels are not yet widespread. However, that could change as industrial customers demand more input.
Managed Care July 2005 Stanley Hochberg	Insurers Can No Longer Afford Not To Share Some Data Pay-for-performance programs imply improved patient care, but are frustrated by fragmented data collection and reporting systems.
Managed Care May 2003	Employer Coalition Leaps at Challenge of Grappling With Misaligned Incentives The executive director of the Leapfrog Group says that the organization pleads guilty to trying to create 'aspirational' standards for health care.
Managed Care April 2000 Michael D. Dalzell	Not-for-Profit Group of Plans Goes After Medicine's Holy Grail Demonstrating long-term health improvement for specific populations is one of managed care's biggest unrealized goals. One group thinks it has the formula.
Managed Care October 2005 MargaretAnn Cross	Just How Will CDHC Change Your Job? Medical directors are charged with many of the tasks that could help members make the most of consumer-directed health plans.
Managed Care March 2004 Martin Sipkoff	Can Transparency Save Health Care? If everyone can see what everyone is doing, we'll have better care at lower costs. First task: Create common standards.
Managed Care October 2007	Data on Quality Lacking for Docs A new report says that insurers are better at providing quality information about hospitals than about physicians.
Managed Care October 2007 John Carroll	Early Tiered Networks Encounter Many Obstacles From dodgy data to uncooperative doctors, difficulties confront health plans that are trying to stratify providers by cost and quality.
Managed Care May 2003	Program Rewards Physicians For Delivering High-Quality Care Bonuses for delivering high quality care will be the focus of a three-market program spearheaded by the National Committee for Quality Assurance and supported by a coalition of physicians, health plans, large employers, and the Centers for Medicare and Medicaid Services.
Managed Care August 2004	Free Database Encourages Wide Sharing of Information on Programs' Outcomes Yes, health care is a business, but altruistic plans would like to cooperate with others. The Leapfrog Group has set up a simple mechanism to do this.
Managed Care February 2005 MargaretAnn Cross	Big Companies Push For Better Online Tools Now that large companies are adding health information to their benefit portals on the Web, insurers will have to work more closely with them.
Managed Care May 2007 Lola Butcher	Massive Databases Under Construction Insurers and employers are busily compiling databases to control costs and improve care, but physicians are laying claim to the data.
Managed Care July 2001 Harry L. Leider	HMOs Need To Share Gains of DM Programs Physicians are more likely to buy in if they see better outcomes -- and financial rewards that go with them...
Managed Care September 2007 Martin Sipkoff	Go Carefully When Measuring Quality Gauging and rewarding good work in health care is a noble goal with potentially negative consequences.
Managed Care June 2002	'We Changed The Way Kaiser Makes Decisions, Views Itself' Lawrence's tenure as Kaiser CEO came at a tumultuous time for the country's largest classic HMO. An interview with David M. Lawrence.
Managed Care June 2001 Jack McCain	Leapfrog Group Actions Will Be Felt Throughout the Health Care System Thanks to a Business Roundtable-sponsored group calling for better outcomes at hospitals, health plans' lobbying efforts may pay off...
Managed Care February 2002 Bob Carlson	Why You Should Care About Improving Clinical Practice Research on quality of care began over 30 years ago. Pages and pages document recent evidence of underuse, overuse, and misuse of resources. Yet only now does change appear imminent, thanks to a growing cadre of passionate reformers who preach clinical practice improvement...
Managed Care January 2004 Martin Sipkoff	Cardiologists Call Collaboration Heart of Effort To Improve Care Surgeons in nine hospitals formed a study group and then hit the road to learn from peers. Outcomes improved dramatically.
Managed Care March 2007 Tom Reinke	NCQA Shifts Focus On Physician Performance NCQA's 2007 HEDIS physician performance manual puts greater emphasis on cost of care. Many organizations, including some health plans, use these specifications to evaluate physician performance.
Managed Care October 2005 Bob Carlson	What Docs Hate Most About Plans Some insurers seem to have a knack for irritating their network physicians. The list is long, but five categories of irritants seem to recur most often.
Managed Care February 2002 Mick L. Diede & Richard Liliedahl	Getting on the Right Track Converging forces are an economic train wreck waiting to happen. Avoiding a disaster requires an understanding of the interconnection of health care's stakeholders and the global consequences of their actions...
Managed Care August 2007 Frank Diamond	Employers Roll Up Their Sleeves No longer passive, companies are working in a variety of ways to improve employees' care. Preventive programs cost money up front, but can cut overall treatment costs to insurers by 30 percent or more, yet few insurers pay for preventive care.
Managed Care December 2005 Ricardo Guggenheim	Putting EBM To Work (Easier Said Than Done) Through widespread implementation of evidence-based medicine, the United States has its best chance of erasing the variations in care that currently extract such huge costs -- both human and financial -- from the health care system.
Managed Care June 2007 MargaretAnn Cross	What the Primary Care Physician Shortage Means for Health Plans Insurers fear rising costs and poorer outcomes if members are less able to get appointments with family physicians and general internists.
Managed Care June 2001	'Quality of care' in eye of beholder The AMA, the Joint Commission on Accreditation of Health Care Organizations, and the National Committee for Quality Assurance have crafted a common set of performance measures for management of adult diabetes...
Managed Care March 2004 John Carroll	Narrow Networks' Broader Vision Throughout the late 1990s, the fashion in managed care networks was bigger and bigger. These days, though, health plans around the country have begun sizing up so-called narrow networks once again.
Managed Care December 2003 Frank Diamond	Dr. Do-Good and Mr. Bottom-Line How medical directors reconcile the contradictory demands of physician and executive roles.
Managed Care September 2001 Jack McCain	Minnesota Buyers Coalition Back On Feet, Plans Expansion An employer group called Minnesota's Buyers Health Care Action Group (BHCAG) tries to contract directly with local groups of health care providers. After setbacks, they're still at it...
Managed Care February 2002 Alan M. Muney	Evidence-Based Medicine Needs To Be Promoted More Vigorously This means using a carrot-and-stick approach with physicians. Those who respect the evidence should be rewarded; others should face penalties...
Managed Care April 2002	What's An E-Mail Consultation Worth? The answer depends on whom you ask. A search of news archives turns up two reported experiments with reimbursement of physicians for e-mail communication with patients...
Managed Care October 2001	Physician Pay Used as Boost For Quality Momentum is building to use physician reimbursement and bonuses not just as utilization controls, but as quality-improvement tools...
Managed Care January 2001 Richard B. Dwore	Study An Opportunity for HMOs To Use Marketing To Increase Enrollee Satisfaction...
Managed Care May 2001	Minnesota Plans, Providers Using Same Guidelines Minnesota's five largest health plans and three major provider systems, including the Mayo Clinic, have agreed to use a standard set of evidence-based treatment guidelines developed by the Institute for Clinical Systems Improvement...
Managed Care July 2007 Tom Reinke	Better Ways to Pay Providers Paying for coordinating care and for packages of services -- bundling and episodes of care -- may be the best bet for a modification of the unfettered fee-for-service system.
Pharmaceutical Executive October 1, 2006	Sales and Marketing: Where the Buck Stops Pharma's ultimate customer is the employer - the guy who pays the health plan's bill. Here's what he wants to know about drugs.
Managed Care November 1999 Steve Wetzell	To Cure Risk Aversion, Employers Eye Risk Adjustment ...The more employers can get consumers involved in the game, the more providers will become directly accountable to consumers. Under traditional managed care, employers -- without realizing it -- have put themselves in the middle of the relationship between physicians and their patients...
Managed Care November 1999 Peter I. Juhn, M.D.	An Evidence-Based Approach To Care Depends on All Parties -- Physicians Included ...transforming the delivery of care into a systematic approach that is based on the best medical evidence -- is dependent on more than just laying out the rules...
Managed Care September 2001 Michael D. Dalzell	Where Will Health Plans Find The Next Generation of Savings? The industry realizes that it needs to get creative -- or perish, at least in the form it has taken. Employers won't stand long for double-digit premium hikes. With much of the fat already wrung out of care delivery, where will health plans find that next generation of cost savings?
Managed Care August 2001	In Calif., Bonuses Based on Quality, Not Cost Savings Blue Cross of California has decided to move away from the traditional managed care incentive of rewarding physicians for controlling medical costs, and instead will implement a program in which physicians receive bonuses for quality of care and patient satisfaction...