The latest blow to managed care?

The Texas attorney general's decision in the Aetna case is the latest in a long string of events that has gutted the fundamentals of managed care. Many in health care think that some or all of these developments — taken together — have stripped health plans of their ability to manage care effectively.

April 2000 -- Texas settles lawsuit against Aetna U.S. Healthcare; insurer agrees not to give financial incentives to physicians for limiting care.

November 1999 -- United HealthCare says it will stop requiring preauthorization for most treatments.

April 1999 -- U.S. Fifth Circuit Court of Appeals says members may take HMOs to state court, upholding Texas's liability law.

April 1999 -- California judge upholds $120 million jury verdict against Aetna U.S. Healthcare in David Goodrich case, calling award high but not excessive.

January 1999 -- InterStudy Publications reveals that less than 1 percent of HMOs are staff-model. The number of staff-model plans — Paul Ellwood's vision of managed care — is down to eight, after 10 folded in 1998.

1998–1999 -- Among workers with employer-sponsored coverage, the share enrolled in HMOs drops, for the first time, in 1998. By 1999, PPOs enroll 43 percent of workers who obtain coverage through employers.

August 1998 -- Texas orders Harris Methodist Health Plan to pay $3.4 million to physicians whom the HMO fined for exceeding pharmacy budgets.

September 1997 -- Kaiser Permanente, Group Health Cooperative, and HIP Health Plans, plus two consumer groups, call for federal enforcement of 18 patient-protection principles — the impetus for the Patients Bill of Rights.

September 1997 -- Texas's first-in-the-nation HMO liability law takes effect.

August 1997 -- New Jersey law requires HMOs in the state to offer a point-of-service option. Nationally, point-of-service plans flourish; Barents survey says 92 percent of people with employer-sponsored coverage have option to choose plan that allows choice of out-of-network physician.

January 1997 -- Federal law mandating 48-hour hospital stays for mothers and newborns takes effect.

1995 -- Maryland, New Jersey, Massachusetts, and North Carolina become first states to pass laws prohibiting "drive-through" deliveries.

1994 -- Maryland law is first to designate Ob/Gyns as primary care physicians, starting open-access trend.


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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.

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