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Managed Care May 2007 MargaretAnn Cross	Following the Leaders Top pay-for-performance programs point to increased focus on hospital incentives, efficiency measures, coordination, and standardization.
Managed Care December 2007 John Carroll	How Doctors Are Paid Now, And Why It Has to Change Everyone knows about the perverse incentive of fee-for-service medicine, but that hasn't had much effect on its use.
Managed Care January 2005 Alice G. Gosfield	P4P: Transitional at Best Pay-for-performance (P4P) programs promise a fair shake for provider and insurance plan, but a former chairman of the National Committee for Quality Assurance sees many design flaws to overcome.
Managed Care June 2005 Martin Sipkoff	The Re-Emergence of the Primary Care Physician A new model of care developed by the American Academy of Family Physicians places primary care physicians back at the center of care delivery.
Managed Care May 2006 Michael Levin-Epstein	Looking for a Better Way To Manage Care Can primary care physicians persuade health plans and Medicare to accept their version of the chronic care model?
Managed Care January 2005 Leary & Farley	Health Plans Slow To Adopt Outpatient Prospective Payment The private sector drags its feet over Ambulatory Payment Classifications. Here are some suggestions to move acceptance along.
American Family Physician November 15, 2006 Liz Smith	Newsletter AAFP adopts new physician workforce policy to counter family physicians shortage... Medicare and Medicaid services propose allowing use of part D data for research initiatives... etc.
Managed Care March 2006 Taylor & Eck	It's Time for CMS to Release Physician Medicare Claim Information The Center for Medicare & Medicaid Services is a rich source of price and quality data. Isn't it about time it shared that data?
Managed Care May 2006 John Carroll	Medicare Debates Fairness of Pay For Primary Care and Specialists A growing controversy in MedPAC and in physician organizations could spill over into how all health plans compensate doctors.
Managed Care August 2007 Martin Sipkoff	Soaring Price of Cancer Drugs Leads Plans To New Approaches Insurers are trying different methods, from pay for performance to promoting preventive care, to hold down cost of chemotherapy drugs.
HBS Working Knowledge April 1, 2015 Carmen Nobel	The Slow, Steady Battle to Fix Cancer Care Thomas Feeley is on a quest to make payment procedures for cancer patients easier, hopefully less expensive, and in the process help change how health care is delivered in America.
Managed Care March 2008	CMS Hybrid Payment System Shows Promise Combining Medicare fee-for-service payments with new incentive programs could help physician groups save money for Medicare and reach quality-of-care targets.
Managed Care July 2005 Martin Sipkoff	Is Pay for Performance Part of the Cure or the Problem? Paying for performance promises improved quality, reduced cost, and higher income for doctors. So why are some of them worried?
Managed Care April 2006 John Carroll	Some Specialist Societies Feel Left Out of AMA-CMS Deal on P4P Many physicians question the fairness of a deal between the American Medical Association and the government that give doctors a bonus when they follow certain rules.
Pharmaceutical Executive May 1, 2005 Erik Felker	Elephant or Specialist? The Bush Administration has put in place the groundwork for new market forces that will forever change how pharmaceuticals are commercialized. Although the long-term impact of this change is not known, unprepared companies are at a serious disadvantage.
Managed Care October 2001 Michael Levin-Epstein	Medicare Demonstration Projects Seek To Coordinate Chronic Care The Centers for Medicare and Medicaid Services is awaiting the results of landmark demonstration programs to determine if improved Medicare services can be furnished to chronically ill patients without increasing costs...
Pharmaceutical Executive August 1, 2012 Debbie Warner	Adapting to a New Era of Cancer Care Coverage and treatment decisions will be driven by value and defined differently by each stakeholder.
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 November 2004 Frank Diamond	DM's Cost-Effectiveness Doubted in CBO Report Congress's financial review agency says that not enough evidence exists to prove that disease management saves money. Many beg to differ.
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.
American Family Physician February 15, 2007	Newsletter Health Care Alliance Announces Proposal to Cover Uninsured... Health Coverage, Physician Payment Are Priorities for AAFP Chapters... Supreme Court Refuses to Hear NRMP Antitrust Lawsuit... etc.
Managed Care January 2008 Marcia Naveh	Lax Coding by Physicians Hurts Medicare Advantage Plans By assisting doctors, insurers can get all the payment that they are due, but that too often is lost.
Managed Care October 2007 John Carroll	Medicare Coverage Rules Are Not Always Last Word Yes, commercial health insurers often take a cue from the government, but that doesn't mean that they follow blindly.
Pharmaceutical Executive March 1, 2014 William Looney	The Call to Community: A Conversation with Dr. David Nash Population health is the foundation for much of what is truly new in US health reform. For big Pharma, it represents yet another escalation in expectations.
Managed Care August 2006 Emad Rizk	Finding Opportunity Where Business Models Meet The next stage of payer-provider collaboration will add true value.
Managed Care December 2006	Compensation Monitor More than half of the nation's HMOs use pay-for-performance programs.
Managed Care July 2007 John Marcille	Perverse Incentives Abound, But Maybe We Can Control Them With all the intellectual capital working on the problem of provider compensation, you'd think perverse incentives would be curbed.
Managed Care May 2007 Frank Diamond	Medicare Advantage Hits Jackpot with Private Fee-for-Service Plans The secret to the success of Medicare private fee-for-service plans is as old as gold. Will beneficiary satisfaction force Congress to keep the faucet turned on?
Managed Care April 2006	Pay-for-Performance Champions Excited by California Program's Success A quality incentive program in California is yielding results that could be replicated in Medicare and other pay-for-performance (P4P) programs nationwide according to a new report.
Managed Care November 2004	Abandonment of Capitation May Inflate MCO's Costs Medical groups and IPAs in strong managed care markets are significantly less likely to use fee-for-service methods to pay their physician members than are organizations in markets with less managed care presence.
Managed Care May 2004 Martin Sipkoff	Will Pay for Performance Programs Introduce a New Set of Problems? Paying incentives to physicians to practice evidence-based medicine appears to be an idea whose time has come. Such programs -- even if successful -- may create a new set of problems.
Nursing Management April 2011 Deborah E. Trautman	Healthcare Reform: 1 Year Later A year after the Patient Protection and Affordable Care Act was signed into law, the nation remains divided.
Managed Care January 2008 Peter Kongstvedt	The Managed Care Forecast Here are some of the challenges that health insurers face this year.
Managed Care May 2002 Patrick Mullen	Interview: Thomas Scilly In a candid, wide-ranging interview, the Centers for Medicare and Medicaid Services administrator counsels patience in solving the myriad problems of health care. A fix could take 20 years
BusinessWeek February 4, 2010 Terhune & Weintraub	Take Your Meds, Exercise -- and Spend Billions Washington wants to pump big money into so-called disease management, though there's scant evidence that it works.
Managed Care March 2006	Standard Measures In Works For P4P Push Uncle Sam has decided to get behind the pay-for-performance effort in a big way, something some physician associations are less than thrilled about.
Managed Care May 2005	Medicare PPOs Face Challenge to Funding All the excitement in the industry about Medicare PPOs died in a hurry last month as the Medicare Payment Advisory Committee (MedPAC) moved closer to recommending that the $10 billion fund for the program be eliminated.
Nursing Management April 2009 Sharon H. Pappas	Profits, Payers, and Patients: Responding to Changes Profit is necessary for hospitals to fulfill their missions, invest in expansion and new technologies, and reinvest in existing patient care infrastructures. Profitability is the work of the financial team and the clinical team to produce the hospital's desired financial outcome.
Managed Care December 2006 MargaretAnn Cross	Confronting The Medicare Cost Shift Plans are increasingly concerned about the degree to which providers overcharge them to make up for losses from government programs.
Managed Care May 2005	New Model, More Money for Family Docs A new practice-level financial model described in the report "Future of Family Medicine" estimates that a five-physician practice could see a 26 percent increase in compensation if it implemented this model and continued to use the current fee-for-service system of payment.
Managed Care June 2002 John Carroll	DM and Medicare: A Marriage Made in Heaven? With a budget of about $230 billion for 40 million patients, many with chronic ailments, is it any wonder that disease management and Medicare are courting?
Managed Care May 2003	Program Rewards Physicians For Delivering High-Quality Care Bonuses for delivering high quality care will be the focus of a three-market program spearheaded by the National Committee for Quality Assurance and supported by a coalition of physicians, health plans, large employers, and the Centers for Medicare and Medicaid Services.
Managed Care April 2001	U.S. Health Care 'Substandard,' Says IOM Report Managed care -- a whipping boy for all that is wrong with health care in the U.S. -- is not to blame for a badly fragmented system that provides incentives to treat acute episodes and not manage chronic illness, according to the Institute of Medicine's landmark report...
Managed Care July 2007	AMA: Patients Will Feel Cuts in Medicare Next year's proposed 10 percent cut in Medicare payments is serving as a rallying point for members of the American Medical Association, which says the cuts will make it difficult for physicians to accept new Medicare patients.
Managed Care October 2005	Headlines On Deadline ... Defensive medicine is something the public seems to be very aware of... Pay-for-performance initiatives got a boost...
Managed Care October 2001 Michael Levin-Epstein	Medicare+Choice Reform: Hope, but No Quick Action Expected There have been small accomplishments, and wheels have been churning for more forceful action -- that is, they were until Sept. 11...
Managed Care May 2004 Frank Diamond	Care Coordination Strikes Right Chord Care coordination -- which, for the purposes of this article, means optimal management of people with multiple chronic diseases to improve outcomes and cut costs -- just suddenly seems a lot more doable. The thing that may make care coordination work this time, is technology.
Managed Care July 2002 Michael D. Dalzell	Has Capitation Weathered the Storm? More difficult than ever to pull off, health care on a fixed, per-capita budget has gone out of style in a number of areas. But many things are cyclical - and this trend may be, too.
BusinessWeek October 1, 2009 Sasseen & Arnst	Why Business Fears the Public Option Executives contend that it will lead health-care providers to charge patients in private plans higher rates.
Managed Care September 2002	Medicare holds down physician pay Compensation increased at a comparatively small rate from 2000 to 2001 for both primary care physicians and specialists, according to the Medical Group Management Association.