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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 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 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 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 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 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 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 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 Martin Sipkoff	Is Pay for Performance Part of the Cure or the Problem? Paying for performance promises improved quality, reduced cost, and higher income for doctors. So why are some of them worried?
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 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 August 2004 Martin Sipkoff	Bad Tiered Formulary Designs Yield Poor Outcomes, High Cost Now that tiered formularies rule the land, what many suspected is being demonstrated: Compliance is suffering and so, too, are patients.
Managed Care December 2004 Martin Sipkoff	A Better Case for Quality: Share the Savings! Brent James's research has led to a new and powerful vision of paying for performance that binds physicians, plans and hospitals together.
Managed Care December 2001 MargaretAnn Cross	Increased Pressures Change P&T Committee Makeup Formulary committees once were stocked with academics and administrators. Today, primary care physicians, specialists, and retail pharmacists play a bigger role, and tomorrow's membership will be even more diverse...
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 May 2007 MargaretAnn Cross	Following the Leaders Top pay-for-performance programs point to increased focus on hospital incentives, efficiency measures, coordination, and standardization.
CIO April 1, 2006 Michael Fitzgerald	The Business Case for Paperless Medicine A strong argument can now be made that doctors in small and midsize practices should invest in electronic health records. Here's how to get your physicians on board.
BusinessWeek April 23, 2009 Catherine Arnst	Doctors' Pride: A Hurdle to Digital Medicine A forerunner in New England found that some physicians would sooner cut ties than see their elite status threatened.
Managed Care April 2006 John Carroll	Some Specialist Societies Feel Left Out of AMA-CMS Deal on P4P Many physicians question the fairness of a deal between the American Medical Association and the government that give doctors a bonus when they follow certain rules.
CFO February 1, 2007 Karen M. Kroll	Pin the Tail on the Doctor A dearth of information leaves health-care consumers in the dark. As health-care information becomes more accessible, will employees use it to purchase health-care services more intelligently?
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 2002 John Carroll	Hospital Copayments: At What Cost? High daily copayments for high-priced hospitals are coming into fashion. It's all about shifting costs, but what about quality of care?
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 July 2003 Ed Silverman	A Little Something For the Physicians Health plans know that getting along with physicians is important, and many are trying new initiatives. Here are some successes.
Managed Care March 2006 Lola Butcher	Major Companies Behind Push for Quality Measures Health plans and employers are convinced that improving quality will save money. This time, they think they've got the data.
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 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 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 April 2000 Tim Olsen	Physician, Tarnish Not Thine Image Doctors who use the news media to criticize others, rather than initiate a constructive dialog about difficult issues such as antibiotic resistance, help erode the profession's influence.
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 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 December 2000 Patrick Mullen	Employer Demands Will Change Healthcare The CEO of a large Florida employer coalition insists that the information that companies are beginning to demand will force the industry to change...
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 December 2006	NCQA Rankings Give Edge to Not-For-Profit Insurers No sooner had the quality rankings of health plans in the nation, as measured by the National Committee for Quality Assurance, been released then it was pointed out that most of the top performers were not-for-profit insurers.
Managed Care May 2003 Martin Sipkoff	Working Together on the Medical Side Partly because of employers' demands, health plans are starting to cooperate in ways that improve care.
Managed Care July 2007 John Carroll	Unlocking a Trove of Quality Data A bill before Congress would give analysts a powerful tool for sifting through Medicare data on the performance of hospitals and physicians.
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.
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 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 March 2000	Tracking the Tracker of Health Care's Trends The president of the Medical Group Management Association encourages changes that would bring physician practice and medical record-keeping in step with the times, and decries the lack of medical standards across plans.
Managed Care January 2006 Martin Sipkoff	Old Techniques Never Die, Nor Even Fade Away Urged on by employers traumatized by costs, health plans are renewing their interest in prior authorization, but using a lighter hand.
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 August 2006 John Carroll	Everyone Uses E-mail Now (Except Doctors and Patients) The doctors in GreenField Health's primary care network learned years ago that e-mail could often satisfy a regular patient's need for medical advice. Here's how the process works today, who pays for it, and when and why it makes sense.
Managed Care April 2004 Martin Sipkoff	Plans Go Directly to Patients, Describing Treatment Options HMOs are developing programs that encourage patients to question their physicians about their treatment options. Doctors are wary.
Managed Care March 2006	Standard Measures In Works For P4P Push Uncle Sam has decided to get behind the pay-for-performance effort in a big way, something some physician associations are less than thrilled about.
BusinessWeek June 25, 2009 Catherine Arnst	The Family Doctor: A Remedy for Health-Care Costs? How making primary-care physicians the center of America's health-care system could drive down costs.
Managed Care May 2004 Frank Diamond	Care Coordination Strikes Right Chord Care coordination -- which, for the purposes of this article, means optimal management of people with multiple chronic diseases to improve outcomes and cut costs -- just suddenly seems a lot more doable. The thing that may make care coordination work this time, is technology.
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 May 2000 Frank Diamond Senior Editor	Medical Director: A Typical Day Requires Both Strength and Tact Ruling on queries from phone banks, working to end hospital errors, meeting with disgruntled physicians: Does any of this sound familiar?
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.