April 1998

Too Many Books: How To Tell the Best Cooks?

So many clinical practice guidelines are issued by various groups that even locating a base of reference can be a task. For health plans, finding guidelines on which to base their own–protocols that promote high quality care, encourage physician buy-in and yet still keep a lid on costs–is no small task. Help may be on the way.

Employers Interested In Disease Management — If It Brings a Return

Also available in PDF

Employers, who pay for most of the nation’s health care, are becoming aware of the possibilities for savings that disease management offers. They’re highly interested in participating, a survey indicates, and are contracting with vendors and health plans–even growing their own programs. Four pages of color charts lay it all out.

Bailing Out of Medicaid Managed Care Programs

For politicians, it was to be an antidote to the feverish rise in Medicaid costs. For beneficiaries, it was supposed to mean new access to mainstream providers and, in many states, an end to what some described as health care segregation. For health plans, it was hailed as a new market. So why are some big HMOs bailing out of Medicaid?

On The Record: Congress Debates Managed Care Reform

Congress is weighing more than 50 managed care reform bills that could affect how your plan does business, and possibly open it to malpractice liability. Here are summaries of the three leading proposals and sponsors’ arguments on their behalf.

Tomorrow’s Technology Is Saving Money Today

A small number of HMOs have been quick to take advantage of technology that has become more fine-tuned and available in recent years. So far, the reviews have been generally favorable. One medical care company has even used off-the-shelf videoconference equipment to take medical services to places that are often difficult to staff–prisons.

HMOs Won’t Look Twice At AMA’s Model Agreement

The AMA’s model managed care contract suggests ways for dealing with doctors’ concerns in the areas of autonomy, counseling and administrative burdens. As such, it focuses on the rights of physicians and patients, which is exactly the AMA’s mission. There’s one problem: Managed care companies are going to be less than enthusiastic.

DEPARTMENTS

Editor’s Memo
Great Taste or Less Filling? Guidelines Have Their Uses

News and Commentary
Oxford Drops Medicaid in 2 States While Its Legal Troubles Deepen
Michigan Battle About Transplant Coverage Ends
AMA Is Top Lobby; Other Health Care Groups Spend Big
Confidence In For-Profits Is Eroding
New York Blues To Send Denials To External Review
Insurer’s Use Of Not-for-Profit Assets Questioned
Falling stocks pull trust down with them [chart]
Managing capitation risk [chart]
Headlines At Deadline…

Washington Initiatives
Medicare Commission Begins Work — Could Overhaul of System Be Next?
Two Agencies: Don’t Change Antitrust Laws
Norwood and Gingrich Butt On Reform Pace
Clinton Orders ‘Bill of Rights’ In U.S. Programs
HHS Contractors To Ratchet Up Antifraud Activity
HCFA Moves Up Report Deadline; AAHP Burns
Take as Needed…

State Initiatives
Terms of California Reform Debate Clearer as Sides Develop Want Lists
Georgia Weighs HMO Malpractice Liability, Mandates
Kentucky: Slowing Managed Medicaid Conversion Down?
Texas Physician Quits as HHS Commissioner
Off-label provisions spread [chart]

Employer Update
System Tries to Boost Productivity by Looking at Total Health Care Picture

Practice Guidelines
CDC Enlists Clinical Advances in Battle Against Sexually Transmitted Diseases

Compensation Monitor
Demand for primary care physicians slackens while outlook for specialists seems to brighten

Legal Forum
Protect Against Outliers That Destroy Your Profitability Under a Contract

Ethics
Direct-to-Consumer Advertising: Helpful or Harmful–or Maybe Both?

Managed Care Outlook
Benefits drive consumers when they pick plans

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