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Managed Care February 2001	Denver Docs Bolt Aetna Before It Ends 'All-Products' Some 8,000 Denver-area residents were left to find new doctors when 240 physicians affiliated with MedWest Medical Group dropped Aetna U.S. Healthcare in a dispute over contract terms. The doctors did not renew their Aetna contract when it expired Jan. 31...
Managed Care May 2000	Texas-Aetna Incentives Settlement Worries Some Capitated Physicians If the Texas deal ignites a trend away from the use of incentives to keep utilization down, then some capitated physicians worry it will put them in a tight spot.
Managed Care December 2000 Maureen Glabman	Downstream Without a Paddle State legislatures that tackle medical group insolvencies have come up with strategies that sometimes shift accountability to HMOs...
Managed Care April 2000 Karen L. Trespacz, J.D.	League of Their Own: What Makes a Winning IPA? In a familiar cartoon, a professor writes long, learned equations on a blackboard. To connect the profundities on either end, he writes in the middle, "Then a miracle occurs." IPAs, done well, are the miracles that connect the ends of health care.
Managed Care November 2000	Aetna Opens Gate With Several New No-Referral Plans Aetna U.S. Healthcare will launch a series of products Jan. 1 that will drop the gatekeeper function. In most cases, the new plans, called Aetna Open Access, will allow members to receive care from specialists without a referral from their primary care physicians...
Managed Care November 1999 Michael D. Dalzell Senior Editor	HMOs, Physicians Discover They Really Need Each Other Some HMOs may be more willing than you think to help financially troubled medical groups survive. A willingness to cooperate is key.
Managed Care April 2000 Mark Abernathy	Avoid Common Problems In Risk-Sharing Contracts These arrangements too often become a hindrance instead of a help. Simple precautions today can help prevent major headaches later on.
Managed Care November 1999 Richard Hamer	Goals 2000: For HMOs: Administrative Retooling For MDs: Managerial Competency ...While HMOs retrench, physicians need to become more constructive participants....
Managed Care May 2000	The latest blow to managed care? The Texas attorney general's decision in the Aetna case is the latest in a long string of events that has gutted the fundamentals of managed care. Many in health care think that some or all of these developments have stripped health plans of their ability to manage care effectively....
Managed Care April 2000	Cigna Colorado Ends Capitation For Most Primary Care Physicians In a strategic move aimed at retaining and recruiting top physicians, Cigna HealthCare of Colorado has dumped capitation. In late February, the insurer began paying most of its physicians in the state on a discounted fee-for-service basis....
Managed Care June 2001 Frank Diamond	HMO/Physician Strain Creates Invisible Costs Perhaps goodwill is too much to ask for. However, peaceful coexistence can certainly help all players reach their mutual goal -- a smooth relationship that helps to get the job done...
Managed Care October 2005 Bob Carlson	What Docs Hate Most About Plans Some insurers seem to have a knack for irritating their network physicians. The list is long, but five categories of irritants seem to recur most often.
Managed Care October 2000	Physicians Praise New Aetna Stance On Kids' Vaccines In California, Aetna U.S. Healthcare has addressed a major complaint of the state's leading physician organization -- that relatively low capitation rates force pediatricians to eat the cost of recommended vaccines....
Managed Care April 2007 Daniel Y. Patterson	HMO - 21st Century Model The history of HMOs has been one of conflict between plans and physicians. Could global specialty capitation be a better way?
Managed Care September 2000 Frank Diamond	'New' Aetna and Kaiser Face Future The biggest for-profit and not-for-profit MCOs have been through rough times recently. How have their corporate cultures changed?
Managed Care May 2004 MargaretAnn Cross	Will Providers Seek New Contracts As Consumer-Directed Plans Grow? Although plans are not restructuring fee schedules in consumer-directed health plans, providers think their agreements need fine-tuning.
Managed Care November 1999	U.S. Supreme Court To Hear Suit Against HMOs Over Incentives Can HMOs be sued for the practice of offering bonuses to physicians who help them keep the cost of care down?...
Managed Care July 2000	Are Gatekeepers Failing To Control Specialty Costs? The importance of a gatekeeper in keeping costs down has been challenged again -- this time in a study that compares physician utilization for HMOs and point-of-service plans.
Managed Care June 2002 John Carroll	States May Become Battleground In Push for Collective Bargaining Physicians at a local Texas hospital gained certification as a bargaining unit, and approached a managed care company to negotiate pay, but the effort failed. A new bill would allow physicians to ease toward collective bargaining nationwide.
Managed Care September 1999 MargaretAnn Cross	It's Too Soon To Write Off Those Suffering PHOs Lessons have been learned from early PHOs, which lacked direction and had misaligned interests between hospitals and physicians.
Managed Care November 2005 Frank Diamond	Physicians and Plans Can Get Along Hill Physicians Medical Group, one of the largest IPAs in the country, has learned to deliver what managed care plans want
Managed Care December 2002 MargaretAnn Cross	Advisory Boards Create Company-Plan Cooperation Very effective if used properly, these panels are not yet widespread. However, that could change as industrial customers demand more input.
Managed Care July 2000	HMO Incentives Not Grounds for Suit U.S. Supreme Court Rules Unanimously Use of financial incentives in HMOs' contracts with physicians may be losing favor, but it's not about to be declared outright illegal any time soon. The U.S. Supreme Court ruled unanimously that patients maynot sue a health plan just because it offers physicians incentives intended to limit health care services.
Managed Care January 2001 David Ricks & Joe Suminski	Nowhere To Go but Out? Tracking Medicare+Choice Managed Medicare's trouble may have something to do with underfunding or rich benefits, but for health plans, market share has a lot to do with it, too...
Managed Care August 2000 Frank Diamond	Nurse Practitioners Inch onto the Field Thanks, in part, to new federal guidelines, this "invisible player" is starting to be noticed. Can NPs do more than fill niches?
Managed Care May 2000 Frank Diamond Senior Editor	Medical Director: A Typical Day Requires Both Strength and Tact Ruling on queries from phone banks, working to end hospital errors, meeting with disgruntled physicians: Does any of this sound familiar?
Managed Care November 1999 Steve Wetzell	To Cure Risk Aversion, Employers Eye Risk Adjustment ...The more employers can get consumers involved in the game, the more providers will become directly accountable to consumers. Under traditional managed care, employers -- without realizing it -- have put themselves in the middle of the relationship between physicians and their patients...
BusinessWeek March 31, 2011 Peter Waldman	Aetna's Rx for High Doctor Fees: Lawsuits Aetna's legal campaign against expensive out-of-network charges is just the latest attempt by insurers to restrain soaring health costs.
Managed Care March 2005 William F. Jessee	What Do Physicians Want From Health Plans? Standardizing health plan administrative processes and eliminating duplication of effort would go a long way toward strengthening the doctor-insurer relationship.
Managed Care June 2007 MargaretAnn Cross	What the Primary Care Physician Shortage Means for Health Plans Insurers fear rising costs and poorer outcomes if members are less able to get appointments with family physicians and general internists.
Insurance & Technology September 16, 2005 Katherine Burger	Educating Consumers A truly technology-enabled offering, the idea behind consumer-directed healthcare is that everyone benefits when consumers have more information.
Managed Care July 2001 Harry L. Leider	HMOs Need To Share Gains of DM Programs Physicians are more likely to buy in if they see better outcomes -- and financial rewards that go with them...
Managed Care October 2000	How you fare under capitation Warren Surveys talked to about 50 HMOs and community based health plans in 1999 to tally what they were paying physicians in capitation and risk-arrangement contracts...
Managed Care December 2002	California Puts Doctor Scores On Report Cards The competency of physician groups is often as important as HMO performance in determining patient outcomes, California health regulators have decided
Managed Care December 2000 Mark D. Abruzzo	Some States Seek To Close Prompt-Payment Loopholes Many states have laws governing the timeliness of claims payments to physicians, hospitals, and other providers, but few such statutes have any real effect because of lack of enforcement or clarity. Some states are toughening their so-called prompt-payment laws, at the expense of insurers...
Managed Care March 2000	Aetna Chief Quits Amid Share Price, Quality Concerns Aetna U.S. Healthcare CEO Richard Huber quits... Fate of Harvard Pilgrim Health Care unknown...
Managed Care November 1999 Karen Ignagni	Health Plans Will Use New Tools To Help Physicians Practice Better For the first time, plans are in a position to work with physicians to improve outcomes, efficiency, and patient safety....
Pharmaceutical Executive May 1, 2006 Musacchio & Hunkler	More Than a Game of Keep Away The Prescribing Data Restriction Program takes effect in July. The AMA explains how individual doctors can keep their prescribing habits safe from reps, and how pharma can keep using the anonymous data -- if the industry polices itself.
Managed Care September 1999 Frank Diamond	Consumers Join The Fray Electoral politics, the Internet, and much more sophisticated patients have all helped to redistribute power among managed care players.
Managed Care November 1999	Headlines On Deadline... MedPartners Inc. renamed to Caremark Rx Inc.... Tufts Health Plan will boost premiums... The Pacific Business Group on Health named Blue Cross of California its 2000 Blue Ribbon health plan...
Managed Care September 2000	Interview: Peter Boland Will the electronic revolution overthrow managed care? Not necessarily, but it may help define a new role for MCOs not far in the future...
Managed Care July 2002 John A. Marcille	Capitation as Whipping Boy: Court Takes on Touchy Issue If plans are to keep coverage decisions reasonable and fair, they'll need tools that involve physicians and patients in the decision-making process. Capitation is one of those.
Managed Care December 2007 John Carroll	New York Plan Emerges As Pattern for Rating Physicians The Empire State's approach to physician ratings quickly gains health plan support and consideration as a national answer.
Managed Care September 1999 Bruce J. Goldstein, J.D. & Mark D. Abruzzo, J.D.	Health Plans That Decredential Docs Must Do It Correctly and Expect a Fight
Managed Care January 2002 Donald Wilcox & Stephanie Kanwit	Debating RICO Suits vs. Health Plans States Failed To Protect Docs From Insurers... Patients Will Suffer; Greedy Lawyers to Blame...
Managed Care November 2000 Bob Carlson	E-Health's Greener Pastures The trend is unmistakable: Physician executives are leaving their high-pressure, high-paying jobs at health plans, and are starting from scratch in the nascent e-health industry. The lure? A chance to leave their mark on something...
Managed Care July 2006 Michael Levin-Epstein	High-Tech Imaging Full of Kickback Dangers Health plans and their members could save billions of dollars a year if radiology costs could be contained. Some managed care companies begin to take a hard look at what's behind the explosion in costs for radiological services.
Managed Care December 2000	Capitation rates see large boost While many physicians argue that HMOs are stingy about passing along revenue from premium increases, a new study suggests otherwise...
Managed Care December 2003 Frank Diamond	Dr. Do-Good and Mr. Bottom-Line How medical directors reconcile the contradictory demands of physician and executive roles.
Managed Care August 2001	In Calif., Bonuses Based on Quality, Not Cost Savings Blue Cross of California has decided to move away from the traditional managed care incentive of rewarding physicians for controlling medical costs, and instead will implement a program in which physicians receive bonuses for quality of care and patient satisfaction...