Vol. 6, No. 7 July 1997

Whatever Happened To Exclusive Contracting?  36

A few years ago, experts predicted that HMOs would be lining up exclusive “teams” of primary care physicians, specialists and hospitals. Was that prophecy wrong, or is its fulfillment just delayed?

Pioneer Not-for-Profit Plans Struggle To Remain Leaders   48

The momentum has shifted to for-profit plans, but don’t count out not-for-profits, particularly these three innovative and–for many enrollees–beloved HMOs. They aren’t resting on their laurels.

‘Needed: A New “Bill of Rights” For Mental Health Care Providers’   54G

Behavioral health care organizations, argues the administrator of one, are being monitored to death. He suggests that a set of ground rules be applied to avoid duplication and ensure fairness to all parties.

Scott Weingarten, M.D., Talks About Clinical Systems to Improve Care   59

Director of health services research at Cedars-Sinai Medical Center in Los Angeles and consulting medical director for PrimeHealth, Weingarten talks of guidelines, profiling and other management systems.

Diary of the Birth Of an HMO   69

Even with hospital money and PPO experience behind you, getting a new HMO started is a daunting proposition. Here’s the candid, step-by-step story of how one Louisiana health plan took the plunge.

Use a ‘SWAT’ Team To Collect Old Receivables   81

In police lingo, ‘SWAT’ stands for Special Weapons And Tactics. It’s an apt metaphor for the team of workers a physician’s office can assign to Solve Worrisome Account Troubles.

Projecting a Leaner Managed Medicare   83

If Congress tightens the belt on Medicare HMOs, it could slow the march of elderly Americans into managed care, creating complications for health plans and physicians. But that march won’t be stopped.

DEPARTMENTS

Editor’s Memo   6
News and Commentary   16
Washington Initiatives   18
State Initiatives   20
Employer Update   28
Compensation Monitor   35
Legal Forum   87
Ethics   89
Managed Care Outlook   92

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