Vol. 8, No. 11 November 1999

HMO Liability Battleground Moving to Courts, Statehouse

Two managed care lawyers say that the debate in Washington may not be as important as developments closer to home.

COVER STORY

After a decade of tumult, what’s next

We asked eight influential participants in the health care system to explain what they consider to be the developments and issues that are likely to dominate the first half of the ’00s.

Health Plans Will Use New Tools To Help Physicians Practice Better
Karen Ignagni, president of the American Association of Health Plans, says IT puts HMOs in a position to help physicians.

An Evidence-Based Approach To Care Depends on All Parties — Physicians Included
Peter Juhn, M.D., of Kaiser Permanente’s Care Management Institute, says three factors in sync can improve outcomes for chronic illnesses.

Irresistible Force Called DM Facing Some Immovable Objects
Al Lewis, president of the Disease Management Association of America, cites Medicare stratification and a new law in California.

To Cure Risk Aversion, Employers Eye Risk Adjustment
Steve Wetzell, executive director of the Buyers Health Care Action Group, wants to see the system encourage appropriate care.

Quality-Measurement Organizations Look Beyond HMO and POS Plans
And that could be the entire health care industry, says NCQA’s Margaret O’Kane. NCQA is looking at PPOs and physician groups.

Consumer Power Will Put HMOs, Physicians on Spot
Consumers will become major players in the game, says advocate Peter Lee, J.D.

Defined Contributions Will Point Employees Toward ‘Health Marts’
Princeton economist Uwe Reinhardt, Ph.D., says employees will shop for their own coverage as companies disengage from insurance.

Goals 2000: For HMOs–Administrative Retooling, For MDs–Managerial Competency
Richard Hamer of InterStudy Publications says HMOs will have to emphasize managed care basics: good primary care and prevention.

HMOs, Physicians Learning They Really Need Each Other

HMOs that are inclined to invest in financially troubled medical groups can reap rewards in their own bottom lines.

PEER-REVIEWED

Financial and Risk Considerations for Successful Disease Management Programs

Actuarial tools such as risk-analysis and risk-projection models can quantify the impact of factors that drive costs in disease management arrangements.

DEPARTMENTS

Editor’s Memo

A Few Clear Voices Will Always Rise Above the Din

News and Commentary

U.S. Supreme Court To Hear Suit Against HMOs Over Incentives
Reform Bill’s OK Prompts Clashes, Dire Predictions
Pharmacy benefits level off in Medicare HMOs [chart]
Medicare Reform Dead for Now On Capitol Hill
New Prescribing Patterns Behind Rx Cost Hikes?
N.J. Regulators Take Hard Look At Diet-Pill Mills
NCQA-AMA Plan Would Reduce Paper Duplication
Another Group Hopes To Measure Quality of Care
Headlines On Deadline…

Washington Initiatives

New provider coalition attacks OIG’s ruling barring gainsharing.

State Initiatives

New California Privacy Law Seen as Major Threat to DM

Compensation Monitor

Group practice managers’ take-home pay is up — except for medical directors [charts]

Ethics

Expanding HMO liability: ethical, but not the point

Legal Forum

Peer review may not be confidential when fairness of process is at issue

Managed Care Outlook

HMOs’ influence felt on brand-name drugs [charts]


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