Headlines At Deadline...

Highmark, the combined Blues plans of Western and Central Pennsylvania, recovered $3.6 million from physicians and other providers during 1997 through retrospective utilization review. Highmark's process of retrospective UR is aided by software that analyzes irregularities in claims patterns, which are then investigated. Highmark says most cases involve billing errors rather than fraud.... Kaiser Permanente lost $270 million in 1997, despite a near 20-percent increase in membership. Kaiser blamed its first-ever loss on higher prescription drug expenses and what it called its failure to foresee the need for higher premiums soon enough.... Fewer students are entering primary care residencies, thanks to what the American Academy of Family Physicians terms a "primary care backlash." AAFP says while 85 percent of primary care residencies offered this year were filled, the number of openings plugged in each of four primary care programs — family practice, pediatrics and two internal medicine residencies — was down for the first time in a decade. Given managed care's influence on specialties, medical school faculty often counsel students to consider careers in primary care. AAFP chalks up the decline to students' frustration with their perceived lack of choice.

Career Opportunities

HAP, a subsidiary of Henry Ford Health System, is a nonprofit health plan providing coverage to individuals, companies and organizations. This executive develops strategies to meet membership and revenue targets through products, pricing, market segmentation and advertising.  Aligns business among Business Development, Commercial Sales, Medicare and Public Sector Programs and Product Development. Seeks to enhance and be responsible for business development and expansion through the development of an effective product portfolio, strong interpersonal relationships and service excellence.

Apply via email to jfedder1@hfhs.org or online at http://p.rfer.us/HENRYFORDlXqAJA

Subscribe to Our Newsletters

Monthly table of contents

Be notified as each issue of Managed Care is available online.

Biweekly newsletter

Recent topics have included:

PTCommunity news

New drug approvals, clinical trials, drug management. Three times per week.