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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....
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 November 1999 Uwe Reinhardt, Ph.D.	Defined Contributions Will Point Employees Toward 'Health Marts' Companies will want to distance themselves from insurance entanglements, giving employees little option but to become more involved....
Managed Care November 1999 Peter I. Juhn, M.D.	An Evidence-Based Approach To Care Depends on All Parties -- Physicians Included ...transforming the delivery of care into a systematic approach that is based on the best medical evidence -- is dependent on more than just laying out the rules...
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...
Managed Care September 2007	NCQA Standards Focus on PPO Performance Preferred provider organizations that are seeking National Committee for Quality Assurance accreditation will now be required to report clinical quality results through HEDIS.
Managed Care November 1999 Al Lewis	Irresistible Force Called DM Facing Some Immovable Objects Disease Management
Managed Care April 2000	NCQA To Put Report Cards On the Web The National Committee for Quality Assurance hopes to elevate the degree to which quality of care factors into people's choice of health plans. NCQA is placing health plan report cards on its web site...
Managed Care December 2002 Margaret E. O'Kane	Taking the Lead for Accountability Critics complain that some HMOs withhold data, but NCQA President Margaret O'Kane responds that HMOs are exemplary in measuring and reporting quality.
Managed Care March 2007	NCQA Toughens Evaluation of PPOs Preferred provider organizations will be evaluated on the same set of standards, clinical measures, and patient experience ratings that the NCQA uses to evaluate HMOs and POS plans.
Managed Care April 2001 Michael Levin-Epstein	PPO Performance Hard To Gauge; Comparisons to HMOs Not Reliable It's long been said that PPOs, by their varied nature, can't be held to the same quality yardsticks as HMOs. Yet, in time, something will have to suffice...
Managed Care November 2005	NCQA Wonders: Who Keeps Tab On Consumer Plans? National Committee for Quality Assurance is worried about the increase of consumer-directed health plans which tend not to measure or report on their performance.
Managed Care December 2001	Survey: HMOs confused about HIPAA privacy regs Though the clock is ticking for HMOs to comply with new privacy guidelines under the Health Insurance Portability and Accountability Act, indications are that many companies are confused about what they need to do...
Managed Care April 2000 Michael D. Dalzell	Not-for-Profit Group of Plans Goes After Medicine's Holy Grail Demonstrating long-term health improvement for specific populations is one of managed care's biggest unrealized goals. One group thinks it has the formula.
Managed Care September 2004	O'Kane Gives the OK To Focus More on Providers The head of the National Committee for Quality Assurance, Margaret E. O'Kane, says health plans want to encourage physicians in the never-ending quest for quality.
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 September 1999	Physicians Seen As Next in Line For NCQA Review The National Committee for Quality Assurance says it will begin an accreditation program for medical groups two years from now....
Managed Care July 2003 MargaretAnn Cross	Money Pit: Is Accreditation Always Worth the Cost? Some plans swear by the benefits of obtaining an "excellent." Others say that customers care much more about cost.
Managed Care November 2007	Substantial Increase Seen in PPO Quality Reporting Interest in PPO quality reporting has expanded to the public sector as well, according to the report. The Medicare program and the federal Office of Personnel Management now require PPO plans to engage in HEDIS reporting.
Managed Care October 2002 John A. Marcille	Has the Time Come for NCQA To Get Tough With HMOs? Perhaps it's just coincidence. The National Committee for Quality Assurance issues its State of Health Care Quality report the same month that a study is published in the Journal of the American Medical Association that dismisses the idea of grading health plans. Talk about irony.
Managed Care March 2000	NCQA Unveils New PPO Accreditation Program, HEDIS '01
Managed Care March 2007 Tom Reinke	NCQA Shifts Focus On Physician Performance NCQA's 2007 HEDIS physician performance manual puts greater emphasis on cost of care. Many organizations, including some health plans, use these specifications to evaluate physician performance.
Managed Care March 2001 Frank Diamond	Don't Be Misled by the Hype: Credentialing -- Important, but Difficult HMOs may be trying harder, but PPOs seem less interested. Then there's the whole issue of credentialing's relationship to the licensure process...
Managed Care March 2000 Mark D. Abruzzo	Beating Obesity Begins By Expanding Tort Reform It's been suggested that, in order to battle obesity, HMOs should use their collective information and knowledge to change their members' behavior....
Managed Care January 2001 Richard B. Dwore	Study An Opportunity for HMOs To Use Marketing To Increase Enrollee Satisfaction...
Managed Care November 1999	NCQA-AMA Plan Would Reduce Paper Duplication ...NCQA will allow health plans to use data from AMA's American Medical Accreditation Program to satisfy NCQA's credentialing standards....
Managed Care July 2000 Neville M. Bilimoria, J.D.	HMOs Continue Losing Ground On Liability Issues at State Level The recent U.S. Supreme Court decision offers a nice breather, but executives should not let down their guard, as an Illinois ruling shows.
Managed Care January 2004 Martin Sipkoff	Transparency Called Key To Uniting Cost Control, Quality Improvement NCQA President Margaret O'Kane and a panel of clinically oriented administrators call for emphasis on making the best care financially attractive to physicians, plans, and employers.
Managed Care September 1999	Headlines on Deadline... Healthcare industry news briefs.
Managed Care March 2001 John A. Marcille	Should That Apple a Day Be Red, Green, or Golden? So if everyone's at least in agreement that preventing illness should be a common goal, why is a mutual understanding of "prevention" so elusive?
Managed Care December 2004	Headlines On Deadline ... Preferred Provider Organizations participating in Medicare Advantage can satisfy federal oversight requirements if they've already received accreditation from the National Committee for Quality Assurance.
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 March 2006	Will HMOs' Robust Profits Make Good Political Fodder? Those looking for any excuse to bash HMOs, including political gain, will turn anything into a weapon, including a recent study pointing to healthy profits.
Managed Care September 2002 Patrick Mullen	Interview: Richard L. Hamer Market-research organization InterStudy's director says that the push for patients' rights has grown into a concern for quality directed mainly at doctors.
Managed Care June 2001	Few Seem To Use POS Option To Go Out of Network Point-of-service plans, in which members can see an out-of-network provider for higher out-of-pocket cost, are among the options employers offer with increasing frequency...
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 June 2001	'Quality of care' in eye of beholder The AMA, the Joint Commission on Accreditation of Health Care Organizations, and the National Committee for Quality Assurance have crafted a common set of performance measures for management of adult diabetes...
Managed Care December 2003 Margaret E. O'Kane	NCQA To Look More Closely At Issues Small Employers Care About Why don't small employers consider health care quality information the same way large employers do when making benefits decisions? We asked the president of NCQA.
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 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 November 1999	Another Group Hopes To Measure Quality of Care There's a new player in quality measurement: the National Forum for Healthcare Quality Measurement and Reporting....
Managed Care May 2001 John Carroll	Two Accrediting Organizations Prepare To Issue DM Standards It's probable that one will become the dominant judge: NCQA or URAC. After it happens, will vendors undergo less scrutiny by individual plans?
Managed Care November 1999 John La Puma, M.D.	Expanding HMO Liability: Ethical, But Not the Point ...Many states are not waiting for the federal debate about expanding HMO liability to play out...
Managed Care December 2006	Compensation Monitor More than half of the nation's HMOs use pay-for-performance programs.
Managed Care May 2002 Sharon Baker	Self-Funded HMOs on the Rise Escalating premiums, changing attitudes play a role in employers' decision to take on the same thing that burned many physicians: financial risk
Managed Care March 2001 Michael D. Dalzell	Preventive Care: Can We Do a Better Job? HMOs place great stock in disease prevention, but some highly recommended services go uncovered. Plans and purchasers often don't agree on priorities...
Managed Care June 2007	Headlines On Deadline ... NCQA has published an expanded set of measures, guidelines, and technical specifications...A new strategy proposed by America's Health Insurance Plans would create an independent entity to compare the safety... etc.
Managed Care January 2002	To Save Money, Employers Reduce Number of Plans Offered to Workers The days of employers scrambling to provide a choice of health benefits packages to lure and keep employees may be ending. The New York Times reports that large companies across the country are sharply reducing the number of HMOs they offer...
Managed Care August 2000 Mark D. Abruzzo, J.D.	Supreme Court Ruling Encourages Greater Awareness Among Patients To you and me, the court's holding in Pegram means that patients cannot sue HMOs under ERISA for giving doctors financial incentives to hold down costs. However, as is typical with many court decisions, this makes one wonder whether it doesn't take on a much greater meaning.
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.