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Managed Care
May 2005
MargaretAnn Cross
Are Consumers Really Directing Their Own Care? In theory, consumer-directed health plans put the reins of decision making into the hands of their members. But medical management departments are alive and well inside CDHPs -- and may even expand under these plan designs. mark for My Articles similar articles
Managed Care
September 2003
MargaretAnn Cross
Consumer-Directed Health Care: Too Good To Be True? People talk about it as the sure way to control costs and give consumers the choice they seem to want. Are we being realistic? mark for My Articles similar articles
Managed Care
June 2005
MargaretAnn Cross
Consumer-Directed and Home-Brewed Regional health plans and small HMOs coming late to the consumer-directed health plan market haven't missed out -- yet. mark for My Articles similar articles
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. mark for My Articles similar articles
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. mark for My Articles similar articles
Managed Care
January 2006
Maureen Glabman
What Doctors Don't Know About the New Plan Designs Physicians are fairly ignorant of what consumer-directed health care will mean to them in terms of relations with patients and health plans. mark for My Articles similar articles
Managed Care
November 2007
MargaretAnn Cross
The Evolving Health Plan The consumer-directed health care model isn't taking the country by storm, but its innovations are influencing other coverage designs. mark for My Articles similar articles
Managed Care
December 2000
Mark D. Abruzzo
Some States Seek To Close Prompt-Payment Loopholes Many states have laws governing the timeliness of claims payments to physicians, hospitals, and other providers, but few such statutes have any real effect because of lack of enforcement or clarity. Some states are toughening their so-called prompt-payment laws, at the expense of insurers... mark for My Articles similar articles
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. mark for My Articles similar articles
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. mark for My Articles similar articles
Managed Care
March 2004
MargaretAnn Cross
Consumer-Directed Plans Begin Measuring Patient Satisfaction Initial results are promising. Employees turn toward preventive medicine and away from expensive drug therapies. mark for My Articles similar articles
Managed Care
November 2004
MargaretAnn Cross
Accrediting Agencies Turn Attention To Consumer-Directed Health Plans If employers make decisions based on United Regional Health Care Foundation's and National Committee for Quality Assurance's rating of traditional managed care plans, shouldn't they want similar ratings of consumer-directed health plans? mark for My Articles similar articles
Managed Care
April 2000
Mark Abernathy
Avoid Common Problems In Risk-Sharing Contracts These arrangements too often become a hindrance instead of a help. Simple precautions today can help prevent major headaches later on. mark for My Articles similar articles
Managed Care
July 2005
MargaretAnn Cross
Momentum Shifts Toward Consumer-Directed Plans Looking at past enrollment shifts and at the evolution of managed care can shed light on how to compete in the new market for account-based consumer-directed care. mark for My Articles similar articles
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. mark for My Articles similar articles
Managed Care
July 2005
Thomas Morrow
Can CDHPs Resolve Issues Raised by Age of Biologics? While the potential of consumer-directed health plans is promising, this design still leaves many questions about coverage unanswered. mark for My Articles similar articles
Managed Care
November 2005
Frank Diamond
Physicians and Plans Can Get Along Hill Physicians Medical Group, one of the largest IPAs in the country, has learned to deliver what managed care plans want mark for My Articles similar articles
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. mark for My Articles similar articles
Managed Care
March 2005
William F. Jessee
What Do Physicians Want From Health Plans? Standardizing health plan administrative processes and eliminating duplication of effort would go a long way toward strengthening the doctor-insurer relationship. mark for My Articles similar articles
Managed Care
June 2001
Bob Carlson
Prompt-Payment Laws Don't Get to Heart of Matter "What we've got here is a failure to communicate," says Strother Martin as the captain in Cool Hand Luke. He's talking about the prisoner Luke, played by Paul Newman -- but he could just as well be explaining why it's so hard for physicians to get their claims paid... mark for My Articles similar articles
Managed Care
October 2004
Consumer-Directed Insurance Plans Problematic for Patients, Docs, HMOs New studies are finding wide variations of cost and quality across hospitals and physicians, yet few private insurers, managed care plans, or public programs reward superior quality or efficiency. mark for My Articles similar articles
Managed Care
February 2002
Industry Braces for Fallout From Docs' Malpractice Woes Malpractice insurance premiums are going up so quickly that many physicians are feeling pressure to stop offering certain procedures, to move to states that are friendlier to medical practices, or even to retire early... mark for My Articles similar articles
Pharmaceutical Executive
August 1, 2012
Andrea Sobrio
Innovative Contracting: What is the Verdict? Industry is finding it harder to secure market access and payer uptake for new products. Innovative contracting may offer a solution. Is it working? mark for My Articles similar articles
Managed Care
August 2007
Consumer-Directed Health Plans: Built to Last or Designed to Fail? A point-counterpoint debate about the effect of CDHPs on overall health and health care costs. mark for My Articles similar articles
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... mark for My Articles similar articles
Managed Care
December 2006
Compensation Monitor More than half of the nation's HMOs use pay-for-performance programs. mark for My Articles similar articles
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. mark for My Articles similar articles
Insurance & Technology
August 2, 2010
Nathan Golia
PHRs Gain Popularity Among Insurers Health insurers are looking to consumer-directed online personal health records as a way to encourage members and providers to share updated healthcare information. mark for My Articles similar articles
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... mark for My Articles similar articles
Managed Care
July 2005
Tony Berberabe
Change in Thinking For Pharmacy Benefits in CDHP The difference between the pharmacy benefit in a consumer-directed health plan and a traditional health plan is greater generic drug utilization. mark for My Articles similar articles
Managed Care
April 2007
A Conversation With Emad Rizk, MD: Disease Management Beyond the Call Center The man who heads McKesson Health Solutions, the third largest disease management program in the country, says it's time to roll out a new model. mark for My Articles similar articles
Managed Care
November 2002
Sharon Baker
Applause, Catcalls Greet Retainer Medicine Proponents tout personalized care and easy access, and imply superior health care. Critics fear "elitist" practices. mark for My Articles similar articles
Pharmaceutical Executive
September 1, 2013
Ben Comer
Share of Screen: Prioritizing Electronic Health Records Are electronic health records a viable channel for engagement? mark for My Articles similar articles
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. mark for My Articles similar articles
Pharmaceutical Executive
March 1, 2013
Al Topin
Less Selling, More Time What can happen when pharmaceutical reps focus on the physician-patient conversation? mark for My Articles similar articles
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... mark for My Articles similar articles
Insurance & Technology
August 18, 2010
Nathan Golia
Insurers Take Lead in EHR Implementation With guidelines for meaningful use of electronic health records established, health carriers expect IT improvements on the provider side to lower healthcare costs by reducing care redundancies and readmissions. mark for My Articles similar articles
Managed Care
January 2002
Donald Wilcox & Stephanie Kanwit
Debating RICO Suits vs. Health Plans States Failed To Protect Docs From Insurers... Patients Will Suffer; Greedy Lawyers to Blame... mark for My Articles similar articles
Pharmaceutical Executive
July 1, 2011
Cabacungan & Clark
New Ways to Gain New Brand Insights If you can learn to understand patient and physician behavior, you are well on your way to strengthening the position of your product. mark for My Articles similar articles
Managed Care
January 2005
Private Practice Physicians Find Dual Role Challenging When it comes to balancing the role of business owner and practicing physician, many private practice doctors are having a tough time of it. mark for My Articles similar articles
Managed Care
October 2000
How you fare under capitation Warren Surveys talked to about 50 HMOs and community based health plans in 1999 to tally what they were paying physicians in capitation and risk-arrangement contracts... mark for My Articles similar articles
Managed Care
August 2005
MargaretAnn Cross
Consumers in This Market Struggle To Keep Their HMOs Rochester, N.Y., faces rising health care costs and a growing employer interest in consumer-directed health plans. Can a managed care town hold its own? mark for My Articles similar articles
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. mark for My Articles similar articles
Commercial Investment Real Estate
Sep/Oct 2009
Andrew Dick
Deal Diagnosis Healthcare real estate transactions not only are driven by economic factors, but also by compliance with federal and state healthcare laws. mark for My Articles similar articles
Managed Care
September 2004
Tony Berberabe
Can Physician and Health Plan Get Together Over Guidelines? Physicians are not the only problem. Health plans too often view guidelines as rigid routines rather than flexible aids to good practice. mark for My Articles similar articles
Managed Care
January 2007
Change From Salary to Relative Value Units Leads to Higher Income for Physicians A Minnesota medical group that contracted with HealthPartners was able to improve cost of care, physician compensation, and patient access without harming patient satisfaction when the group converted from a salary payment system for physicians to one solely dependent on physician productivity. mark for My Articles similar articles
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. mark for My Articles similar articles
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. mark for My Articles similar articles
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. mark for My Articles similar articles
Pharmaceutical Executive
September 1, 2012
Al Topin
Doctors' Words No Longer Gospel In the digital age, physicians don't call the shots when it comes to healthcare guidance. Marketers must appeal to multiple sources in seeking ways to garner patient adherence and loyalty. mark for My Articles similar articles