It's all well and good to know that H. pylori causes peptic ulcer disease. But putting this knowledge to work curing ulcers — and saving money — means making sure the patient actually takes the pills.
Managed care owes much of its financial success to the "gatekeeper" system. But some health plans are tinkering with that model in hopes of providing care even more cost-effectively.
The "gatekeeper" model for controlling health care utilization is inherently flawed, argues this physician, who says substituting a more flexible system could save money as well as improving health care.
In drawing up contracts, HMOs aren't shy about asking for terms favorable to themselves. Here, five health care attorneys discuss the most outrageous HMO demands they've encountered. Watch out for clauses like these.
Friends and foes of "any-willing-provider" legislation don't line up as predictably as they once did. And even in the states that have enacted such laws applying to physicians, AWP is turning out to be a less ferocious beast than its backers had hoped.
John La Puma, M.D.
Neil Caesar, J.D.
Managed Care Outlook