April 1997

Workers’ Comp: Can Managed Care Fix It?  31

Workers’ compensation is attracting managed care companies because they can, more effectively than individual providers, concentrate on what’s really important to employers–getting injured workers back on the job.

Fraudulent Workers’ Comp Cases  49

The idea of teamwork pervades health care these days, and it applies in a distinct way to workers’ comp, where the physician may be expected to identify fraudulent claims. Fortunately, they’re often easy to spot.

Have You Had Your Day Out of Court?  52

Many large institutions–HMOs for example–have learned the advantages of resolving disputes outside the legal system, using processes that are fair to both sides. These approaches, such as mediation and arbitration, can benefit individuals, too.

An Interview With AHCPR’s Carolyn Clancy, M.D.  56

For the newly appointed director of the Center for Outcomes and Effectiveness Research at the federal Agency for Health Care Policy and Research, putting in one night a week as a practicing internist is a helpful reality check.

Defeat of Propositions 214 and 216: The End of Health Care Reform?  60

A physician considers California voters’ rejection of two managed care reform measures and what it means for the future. Change will continue, he predicts, as consumers “vote” with premium dollars rather than ballots.

Reinventing the PBM  64

Having transformed the market, pharmacy benefit management companies are now in for some shaking up themselves, experts agree. Among the possible results: widespread use of closed drug formularies.

Avoiding ‘Bad Faith’ Denials of Medical Claims  79

It’s one of the most thankless jobs in health care: denying a patient’s request for medical treatment. Before making such a decision, follow these steps to avoid bad-faith denials, advises an experienced medical director.

Have You Tried These Six Time-Savers?  86

When magazines like this one recommend some action as “worth the time it takes,” do you wonder where the time is supposed to come from? This article may help.

Capitation Contracts: Time for a New Attitude  93

As the health care market evolves, physicians will be wise to adopt new ways of dealing with managed care organizations, says this consultant, especially when it comes time to ink capitation contracts.

DEPARTMENTS

Managing Editor’s Memo  9
News and Commentary  14
Washington Initiatives  17
Employer Update  24
Compensation Monitor  30
Ethics  95
Legal Forum  103
Outcomes Management  105
Managed Care Outlook  106

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