Vol. 8, No. 3 March 1999


Liability’s Jaws Closing on HMOs

Denials of care are coming back to bite. Prepare for the inevitable.

How HMO Did Right but Lost Anyway

A Humana VP writes about the Karen Johnson case.

Will Insurance Cover Punitive Damages?

A lawyer looks at why HMOs could be left holding the bag.

External Review Might Be the Best Defense

How Health Net’s program has fared in California.

Best Method for Third-Party Review

Base judgments on how plans decide on denials, says this lawyer.

When Doctors Take On Medicare Risk…

…they could sink without understanding lessons HMOs learned.

Q&A: Champion of a Single-Payer System

Quentin Young, M.D., doesn’t oppose markets. Just the results.

HEDIS Turns Its Attention to Chronic Care

More than ever, physician performance will affect NCQA scores.



Editor’s Memo

News and Commentary
As HMOs Recover, Signs Emerge That 1999 Could Be a Good Year
After Big Case, Aetna Goes After Own Reinsurers
In N.J., Officials Begin Liquidating HIP Health Plan
California Orders Drugs Restored To 6 Formularies
Another PBM Sold As Express Scripts Buys Diversified
Florida Hospitals Say HMOs Playing Games With Claims
Colorado Doctors Tell Older Patients To Join An HMO
Buyers of physician practices becoming smarter shoppers [chart]
State mandates expand for external review, direct access [chart]
Headlines On Deadline…

Washington Watch
Medicare Fraud Initiative Makes Strange Bedfellows

State Initiatives
Others Await Promise of Mississippi’s Experiment With Pharmaceutical Care

Employer Update
Concern About Premium Hikes Rises As Plans’ Ability To Cut Costs Questioned

Compensation Monitor
Primary care physicians worked harder and were rewarded, if not commensurately

Legal Forum
Persuade the HMO That a Contract Change You Propose Is Also In the Plan’s Interest

Trust Should Be Thrust of Managed Care System

Managed Care Outlook
Employer retention big motivator for HMOs’ workers’ comp activities

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