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Managed Care December 2007	Web Site Helps Track Health Plan Rankings U.S. News & World Report and the National Committee for Quality Assurance have released the third edition of America's Best Health Plans, an annual ranking of health maintenance organizations and point-of-service plans.
Managed Care March 2008 Frank Diamond	What Makes Harvard Pilgrim So Good? It's the nation's leader in member satisfaction and quality of care, according to NCQA. Dynamic leadership and dominance of a region where excellent docs and plans abound are part of the formula.
Managed Care January 2005	NCQA Hopes 10-Best Lists Spur Consumer Interest Medicaid Top 10: BlueCross BlueShield of Western New York... HealthPlus of Michigan... UPMC Health Plan... Medicare Top 10: Blue Cross and Blue Shield of Massachusetts... Capital Health Plan... HealthPartners... etc.
Managed Care April 2000	Financial Stability Of HMOs Called A Mixed Bag An HCIA-Sachs survey says the median HMO profit margin in 1998 was -1.7 percent, slightly better than in 1997. Forty-one percent of HMOs made money in 1998....
Managed Care January 2005 Ed Silverman	The Comeback Kid: Harvard Pilgrim Health Care The health plan was listing badly when Charles Baker boarded it in 2000. Since then, the ship has been righted and the way is clear.
Managed Care March 2000	Aetna Chief Quits Amid Share Price, Quality Concerns Aetna U.S. Healthcare CEO Richard Huber quits... Fate of Harvard Pilgrim Health Care unknown...
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 September 1999	Headlines on Deadline... Healthcare industry news briefs.
Managed Care January 2007	Headlines on Deadline ... State budgets got an unexpected gift last year... Mortality rates for hospitals ranked high... It looks likely that Massachusetts Gov. Mitt Romney will run for president... etc.
Managed Care December 2006	Compensation Monitor More than half of the nation's HMOs use pay-for-performance programs.
Managed Care November 2003 John Carroll	"Concierge Care" by Any Name Raises Ethical Concerns Medical directors at managed care organizations have been hard-pressed to come to a consensus on just how -- or whether -- this new wrinkle in the managed care business fits in.
Managed Care December 2004	Headlines On Deadline ... Preferred Provider Organizations participating in Medicare Advantage can satisfy federal oversight requirements if they've already received accreditation from the National Committee for Quality Assurance.
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 March 2008	Proposed 2009 HEDIS Measures Address Immunization, Obesity Rates The National Committee for Quality Assurance wants to expand what the committee's Healthcare Effectiveness Data and Information Set (HEDIS) measures look at in 2009.
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 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 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.
HBS Working Knowledge July 12, 2006 Roger Thompson	Competition the Cure for Healthcare Michael Porter is considered by many the world's foremost authority on competition and strategy. So when he discusses the need for fundamental reform in the way the United States delivers healthcare, people listen.
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 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.
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.
Insurance & Technology August 26, 2004 Babcock & McGee	Filter Out the Frauds Health insurers fight back against fake claims with fraud-detection software.
Managed Care November 1999	Headlines On Deadline... MedPartners Inc. renamed to Caremark Rx Inc.... Tufts Health Plan will boost premiums... The Pacific Business Group on Health named Blue Cross of California its 2000 Blue Ribbon health plan...
Managed Care April 2005 Frank Diamond	Starting Medicare Advantage Plan Brings Special Set of Problems The feds will help you launch a health plan for the elderly, but just what does it take to get something like this operating in so short a time?
Managed Care September 1999	Physicians Seen As Next in Line For NCQA Review The National Committee for Quality Assurance says it will begin an accreditation program for medical groups two years from now....
Managed Care October 2007 John Carroll	Medicare Coverage Rules Are Not Always Last Word Yes, commercial health insurers often take a cue from the government, but that doesn't mean that they follow blindly.
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 February 2004	Access Equal In For-Profits, Not-For-Profits? Scientific studies sometimes produce surprising conclusions, and one published last month in the New England Journal of Medicine, indicating that for-profit health plans involved in Medicare+Choice provide just as much access to high-cost medical procedures as not-for-profit competitors, certainly did.
Managed Care October 2003 MargaretAnn Cross	Some HMOs See Dividends In Charging Deductibles This may be one way to regain profitability, though getting permission from government regulators may take some doing.
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 December 2007 John Carroll	New York Plan Emerges As Pattern for Rating Physicians The Empire State's approach to physician ratings quickly gains health plan support and consideration as a national answer.
Managed Care January 2001 David Ricks & Joe Suminski	Nowhere To Go but Out? Tracking Medicare+Choice Managed Medicare's trouble may have something to do with underfunding or rich benefits, but for health plans, market share has a lot to do with it, too...
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 December 2005 John Carroll	Consumers Don't Know What They Don't Know Experts have been taking a close look at health literacy in America and have concluded that this is one area where even relatively well-educated people will have trouble finding their way.
Commercial Investment Real Estate Sep/Oct 2009 Andrew Dick	Understanding Federal Healthcare Laws Commercial real estate professionals who work with medical office development must be aware of the federal healthcare fraud and abuse laws.
Insurance & Technology September 16, 2005 Katherine Burger	Educating Consumers A truly technology-enabled offering, the idea behind consumer-directed healthcare is that everyone benefits when consumers have more information.
Managed Care September 2001 Bob Carlson	Plan-Provider Posturing Draws State Regulators' Ire Network instability is what happens when providers and health plans part company, or threaten to. Lately, many ugly rifts have been the result of contract disputes, invariably conducted in public...
Managed Care January 2005	Headlines on Deadline... More on the pay-for-performance push... The nation's HMOs operated on a slim profit margin in the first three months of 2004... Health coverage is not a factor in determining the level of care children receive in the U.S... etc.
The Motley Fool March 23, 2007 Dan Caplinger	Who's the Best Health Insurer? A recent survey shows that public companies aren't making the grade. Investors, it's important to remember that these companies are at a competitive disadvantage to some of their counterparts.
Insurance & Technology August 12, 2005 Lisa Valentine	Partnering for Success Tufts Health Plan CIO Tricia Trebino discusses Tufts' technology strategy.
BusinessWeek June 23, 2011 Drew Armstrong	The Simplest Rx: Check on Your Patient Doctors and insurers cut costs by sharing information.
Managed Care June 2003	For-profit, not-for-profit enrollment holding about steady While HMOs seemed to be losing enrollees to PPOs, the ratio of enrollees in for-profit and not-for-profit HMOs stabilized in the late 1990s, according to data collected by the Centers for Medicare and Medicaid Services.
Managed Care February 2004	Not-for-Profit Advocate Calls for Managerial Rigor Boards and managers need to perform better for this sector to continue offering the best care to those who might otherwise fall through the cracks.
Managed Care November 2000	Headlines On Deadline Researchers studying 46,000 employees in six large companies found that 25 percent of medical claims could be linked to lifestyle choices, such as diet, exercise, and smoking... Health plans' HEDIS performance is influenced by socioeconomic factors... etc.
Managed Care November 2007	Substantial Increase Seen in PPO Quality Reporting Interest in PPO quality reporting has expanded to the public sector as well, according to the report. The Medicare program and the federal Office of Personnel Management now require PPO plans to engage in HEDIS reporting.
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 August 2006	Headlines On Deadline ... Aetna is unveiling something it calls the Medicare Open Plan, targeted for employers who want to offer retirees age 65 or over a fee-for-service Medicare Advantage plan.
Managed Care August 2004	Medicaid Fees Rise, But Still Below Medicare A recent study reports that 30 states raised their Medicaid fees at or above the rate of inflation, including 10 that raised physician fees by more than 35%.
Managed Care September 2000 John A. Marcille	Kaiser, Aetna Keep Eyes On Health Care Consumer Sometimes breaking old ground can be just as satisfying as breaking new. What these two plans are looking at, experts believe, is a health care system moving toward defined contributions...
Managed Care September 2007	NCQA Standards Focus on PPO Performance Preferred provider organizations that are seeking National Committee for Quality Assurance accreditation will now be required to report clinical quality results through HEDIS.