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Managed Care May 2000	Texas-Aetna Incentives Settlement Worries Some Capitated Physicians If the Texas deal ignites a trend away from the use of incentives to keep utilization down, then some capitated physicians worry it will put them in a tight spot.
Managed Care May 2001 Jack McCain	Use of Hospitalists: Another Case of 'May' vs. 'Must' Despite a movement to ban mandatory use of these physicians, their numbers and influence are rising as their roles become better understood...
Managed Care April 2000 Karen L. Trespacz, J.D.	League of Their Own: What Makes a Winning IPA? In a familiar cartoon, a professor writes long, learned equations on a blackboard. To connect the profundities on either end, he writes in the middle, "Then a miracle occurs." IPAs, done well, are the miracles that connect the ends of health care.
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 July 2000 Neville M. Bilimoria, J.D.	HMOs Continue Losing Ground On Liability Issues at State Level The recent U.S. Supreme Court decision offers a nice breather, but executives should not let down their guard, as an Illinois ruling shows.
Managed Care July 2000 John Carroll	Physicians Reconsider Taking On Pharmacy Risk They've been burned here in the past, but physicians - and the HMOs that they contract with - may have learned some lessons.
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...
Managed Care October 2000 Maureen Glabman	Giving Some Ground to Physicians Helped Turn Health System Around One hospital system accepted the general wisdom a few years ago by acquiring physician practices. Now it bucks the new wisdom by holding on to them...
Managed Care April 2007 Daniel Y. Patterson	HMO - 21st Century Model The history of HMOs has been one of conflict between plans and physicians. Could global specialty capitation be a better way?
Managed Care August 2000 Bob Carlson	'All Products' Clauses Fade From Physician Contracts All-products provisions in health plan provider contracts are slowly being negotiated, legislated, and regulated out of existence. They are now illegal in at least four states; legislation is pending in several others.
Managed Care July 2002 Michael D. Dalzell	Has Capitation Weathered the Storm? More difficult than ever to pull off, health care on a fixed, per-capita budget has gone out of style in a number of areas. But many things are cyclical - and this trend may be, too.
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 December 2002	California Puts Doctor Scores On Report Cards The competency of physician groups is often as important as HMO performance in determining patient outcomes, California health regulators have decided
Managed Care December 2006	Compensation Monitor More than half of the nation's HMOs use pay-for-performance programs.
AskMen.com April 15, 2001 Joshua Levine	Choosing The Right Doctor Choosing a doctor is one of the most important decisions you can make. It's probably best made when you are healthy and have some time to think about a number of possibilities. If you don't have a doctor or are thinking about changing doctors, now may be the best time to look...
Managed Care March 2001 Frank Diamond	Don't Be Misled by the Hype: Credentialing -- Important, but Difficult HMOs may be trying harder, but PPOs seem less interested. Then there's the whole issue of credentialing's relationship to the licensure process...
Managed Care July 2000	Lee N. Newcomer joins Vivius The former senior VP for health policy at UnitedHealth Group joins a company that aims to shift power from HMOs to patients and physicians.
Managed Care September 1999 MargaretAnn Cross	It's Too Soon To Write Off Those Suffering PHOs Lessons have been learned from early PHOs, which lacked direction and had misaligned interests between hospitals and physicians.
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 December 2000 Maureen Glabman	Downstream Without a Paddle State legislatures that tackle medical group insolvencies have come up with strategies that sometimes shift accountability to HMOs...
Managed Care November 1999 Michael D. Dalzell Senior Editor	HMOs, Physicians Discover They Really Need Each Other Some HMOs may be more willing than you think to help financially troubled medical groups survive. A willingness to cooperate is key.
Managed Care August 2000 Mark D. Abruzzo, J.D.	Supreme Court Ruling Encourages Greater Awareness Among Patients To you and me, the court's holding in Pegram means that patients cannot sue HMOs under ERISA for giving doctors financial incentives to hold down costs. However, as is typical with many court decisions, this makes one wonder whether it doesn't take on a much greater meaning.
Managed Care November 1999 Richard Hamer	Goals 2000: For HMOs: Administrative Retooling For MDs: Managerial Competency ...While HMOs retrench, physicians need to become more constructive participants....
Managed Care September 1999 Frank Diamond Senior Editor	Florida Medicaid Moves Toward Direct Contracting Florida will soon test a program that could provide competition for HMOs serving the Medicaid population. Other states are watching.
Managed Care May 2007 David A. Sparrow	Pay for Performance: As Much About Costs as About Quality You don't really have a true pay-for-performance program if it doesn't say so on the bottom line.
Managed Care August 2001 John Carroll	Info on Questionable Physicians Languishes in National Data Bank A clearinghouse was created that stores details about malpractice suits and disciplinary actions. So how come HMOs don't use it?
Managed Care November 1999 Arthur L. Baldwin III	Financial and Risk Considerations for Successful Disease Management Programs Results for disease management programs have not been as positive as hoped because of clinical issues, lack of access to capital, and administrative issues....
Managed Care July 2001 John Otrompke	Stark Allows Federal Regulators To Review Claims Records Fully HMO executives, as well as the providers and physicians who contract with them, should have by now felt the changes in their daily work lives resulting from the government's increased scrutiny of health plans' operations under the fraud-and-abuse compliance laws...
Managed Care May 2004 MargaretAnn Cross	Will Providers Seek New Contracts As Consumer-Directed Plans Grow? Although plans are not restructuring fee schedules in consumer-directed health plans, providers think their agreements need fine-tuning.
Managed Care September 1999 Bruce J. Goldstein, J.D. & Mark D. Abruzzo, J.D.	Health Plans That Decredential Docs Must Do It Correctly and Expect a Fight
Managed Care September 2002 Patrick Mullen	Interview: Richard L. Hamer Market-research organization InterStudy's director says that the push for patients' rights has grown into a concern for quality directed mainly at doctors.
Managed Care May 2000	Physicians Fudge Insurance Forms To Help Patients A study confirms what has long been considered common but is rarely discussed: Physicians often lie about patients' conditions to gain or improve coverage for their treatment.
Managed Care November 1999 Karen Ignagni	Health Plans Will Use New Tools To Help Physicians Practice Better For the first time, plans are in a position to work with physicians to improve outcomes, efficiency, and patient safety....
Managed Care August 2001	Four Views of Managed Care Ethics The evolution of managed care has posed ethical problems for physicians, plan administrators, and even patients. Four ethicists find that questions are many, while satisfactory answers are in short supply...
Managed Care August 2001 Frank Diamond	Consumers Dare You to Just Say 'No' The backlash has helped push a Patients' Bill of Rights forward, challenging the very nature of cost containment. Ironically, enrollees may be shortchanged...
Fast Company April 2006	"MD" Doesn't Mean "Mostly Digital" How technologically backward are U.S. doctors? Here are some statistics.
AskMen.com Tara Weiss	Reasons Not To Become A Doctor There were once many rewards to being in the medical profession. For decades, doctors earned hefty paychecks, had autonomy and respect. Those benefits are fading, and as a result, so is the number of doctors.
Financial Planning July 1, 2011 Suzanne Sataline	Code Blue? Many financial planners say their physician clients are fretting that they won't have enough money saved to retire on schedule, and that their savings won't hold through their elderly years.
CIO December 15, 2009 Kim S. Nash	Data Sharing That Benefits Customers At Children's Hospital Boston, sharing more data, securely, promises healthier, more satisfied patients.
Nursing Management September 2011 Sally Austin	What does EMTALA mean for you? When a patient enters your hospital, do you know what your obligations are under the Emergency Medical Treatment and Active Labor Act?
Managed Care March 2002 Mildred Beam-Rucker	'Team Approach' to Contract Talks Means That Nobody Feels Cheated Managed care is a business. Both parties want a profitable relationship, and while profitability is important, providers and managed care organizations seem to have more success when they identify a joint mission for the relationship and take a team approach to contracting...
Managed Care August 2000 Frank Diamond	Nurse Practitioners Inch onto the Field Thanks, in part, to new federal guidelines, this "invisible player" is starting to be noticed. Can NPs do more than fill niches?
CFO May 1, 2009 Josh Hyatt	Strong Medicine Boosted by a substantial injection of cash from the federal stimulus bill, electronic medical records may help relieve the pain of rising premiums by improving efficiencies in the medical system.
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 June 2006	Fewer Doctors Contract with Managed Care Although it was stable in the mid-1990s, the proportion of physicians without any managed care contracts rose from 9.2 percent in 2000-2001 to 11.5 percent in 2004-2005, according to a report.
AskMen.com Dustin Driver	How To Check A Doctor's Credentials Here's a five-step plan to finding a good doctor.
Inc. September 2007 Cara Cannella	How I Did It: Todd Johnson, President and CEO, Hospital Partners of America Cost pressures may be straining health care providers, but there is money in the hospital business.
Managed Care December 2007 John Carroll	How Doctors Are Paid Now, And Why It Has to Change Everyone knows about the perverse incentive of fee-for-service medicine, but that hasn't had much effect on its use.
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 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.