Managed Care



August 1997

The time lag between when an employee makes a coverage choice and when the plan receives notification from the employer's personnel office can result in expense and problems for patients, physicians and the plan.
Joseph S. Bigley
Now that quality is an industry obsession, it makes sense to find ways of paying your 'best' doctors more. But does 'best' just mean immunizations and a patient-friendly office?
By Deborah Epstein
Not too long ago, disease management was viewed with widespread suspicion. But the evidence mounts that well-designed programs make medical sense and can help patients as well as the bottom line.
Peter Wehrwein
Health plans and physicians have every right to hold down the cost of pharmaceuticals, as long as patients aren't harmed. But not everyone agrees on what actions are acceptable.
Richard R. Abood, R.Ph., J.D.
Accounting for 12 percent of federal spending this year and projected to consume 15 percent of the budget in 2002 if not reined in, Medicare in 1997 is on the road to profound change.
While development of depression management programs has lagged behind other chronic conditions, emphasis is now being placed on early diagnosis and treatment coordinated by primary care physicians.
Jon Ross
You might not expect to hear the term "smoosh" from the lips of one of health care's most erudite observers. But he would argue that the rest of the industry's vocabulary should be as clear.
When Harris Health System began posting losses, it became apparent that a new compensation system, with incentives to providers to control costs, was in order. Risk sharing was the answer.
Neil A. Godbey
On the theory that capitating primary care can lead to unnecessary referrals, a group of California physicians has decided to pay fees to primary care and to capitate specialists. It seems to work.
Shelley Kullman
How do you devise a capitation plan that works? With understanding, hard work and gumption, says the chief financial officer of Sharp Rees-Stealy Medical Group in San Diego.
Keith Alan Moore
Some academic researchers warn that managed care's emphasis on low-cost care means that plans won't support expensive research at academic medical centers. Industry representatives say research is not being ignored.
Joan Szabo
Physicians and hospitals have always been subject to liability claims, but now health plans are becoming vulnerable too. Adverse events cannot be eliminated, but there are many ways to reduce liability exposure.
Allen D. Spiegel, Ph.D., M.P.H. & Florence Kavaler, M.D., M.P.H.


2014 Annual HEDIS® and Star Ratings Symposium Nashville, TN November 3–4, 2014
PCMH & Shared Savings ACO Leadership Summit Nashville, TN November 3–4, 2014
Medicare Risk Adjustment, Revenue Management, & Star Ratings Fort Lauderdale, FL November 12–14, 2014
World Orphan Drug Congress Europe 2014 Brussels, Belgium November 12–14, 2014
Healthcare Chief Medical Officer Forum Alexandria, VA November 13–14, 2014
Home Care Leadership Summit Atlanta, GA November 17–18, 2014
6th Semi-Annual Diagnostic Coverage and Reimbursement Conference Boston December 4–5, 2014
Customer Analytics & Engagement in Health Insurance Chicago December 4–5, 2014
Pharmaceutical and Biotech Clinical Quality Assurance Conference Alexandria, VA December 4–5, 2014
9th Semi-Annual Medical Device Coverage and Reimbursement Conference San Diego December 5, 2014
8th Annual Medical Device Clinical Trials Conference Chicago December 8–9, 2014
HealthIMPACT Southeast Tampa, FL January 23, 2015