MANAGED CARE April 1998. ©1998 Stezzi Communications
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.