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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. |
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? |
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. |
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 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 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. |
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. |
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... |
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 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 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. |
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? |
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. |
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. |
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 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. |
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 |
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 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. |
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... |
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. |
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... |
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? |
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. |
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 December 2006 |
Compensation Monitor More than half of the nation's HMOs use pay-for-performance programs. |
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. |
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. |
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 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. |
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. |
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. |
Pharmaceutical Executive September 1, 2013 Ben Comer |
Share of Screen: Prioritizing Electronic Health Records Are electronic health records a viable channel for engagement? |
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. |
Pharmaceutical Executive March 1, 2013 Al Topin |
Less Selling, More Time What can happen when pharmaceutical reps focus on the physician-patient conversation? |
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... |
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. |
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... |
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. |
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. |
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... |
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? |
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. |
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. |
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. |
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. |
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 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 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. |
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. |