Vol. 6, No. 8 August 1997

How Health Plans Do–and Don’t– Reward the ‘Best’ Physicians  29

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 success in the patient satisfaction survey sweepstakes?

Disease Management Gains A Degree of Respectability  39

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.

Cut Pharmaceutical Costs, But Mind the Legal Dangers  47

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 cost-cutting actions are acceptable.

Online Employee Enrollment Systems Can Lower Costs, Improve Communication   60A

When employees can sign up or change benefits on line, plans and physicians can have immediate access to the information.

Managed Medicare’s Rapid Expansion: Enrollment May Triple in 10 Years  61

Also available in PDF

Accounting for 12 percent of federal spending this year and projected to consume 15 percent of the budget in 2002 if not reined in, the Medicare program in 1997 is on the road to profound change.

Health Care Systems Slow To Pursue Comprehensive Depression Management  69

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.

Interview: Alan Hillman, M.D., M.B.A.  75

The University of Pennsylvania physician-economist calls for health plans to work together in their regions to create practice guidelines.

How Three Physician Groups Faced the Issue of Capitation  88

With HMOs often insisting on paying physicians by capitation, doctors have to decide whether to base individual compensation on that system. Some go with the flow; others swim against it successfully.

Does Managed Care Hamper Research?   114

Some academic researchers warn that emphasis on low-cost care means that health plans won’t support expensive research at academic medical centers. The industry says research is not being ignored.

Better Patient Communications Mean Lower Liability Exposure   119

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 ways to reduce the danger.


Managing Editor’s Memo  6
News and Commentary  9
Employer Update  21
Washington Initiatives  23
Compensation Monitor  27
State Initiatives  28
Ethics  125
Legal Forum  127
Managed Care Outlook  130

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