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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 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 November 1999 Margaret E. O'Kane	Quality-Measurement Organizations Look Beyond HMO and POS Plans Now that the hard part -- forging quality-measurement systems for HMOs and point-of-service plans -- has been done, the next step is to adapt these programs to the rest of the health care industry....
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 April 2000 Mark D. Abruzzo, J.D.	Despite What You Hear, State Privacy Statutes No Threat to DM In Managed Care's November 1999 issue, Al Lewis, president of the Disease Management Association of America, wrote about potential pitfalls facing DM. One identified by Lewis was state privacy laws, a topic that merits further attention....
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 December 2001	Disease Management Outsourcing As DM shifts its focus to outcomes-based care, the EVP of American Healthways suggests that larger health plans consider outsourcing care of chronic patients.
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 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 November 1999 Arthur L. Baldwin III	Financial and Risk Considerations for Successful Disease Management Programs Results for disease management programs have not been as positive as hoped because of clinical issues, lack of access to capital, and administrative issues....
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 June 2003 Alison Johnson	Measuring DM's Net Effect Is Harder Than You Might Think Disease management is God's gift to managed care. Or is it? Here is a discussion of areas that make evaluating a DM program a complex, if not ineffable, proposition.
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...
Knowledge@Wharton July 30, 2003	Restructuring Medicare Is a Riskier Operation than First Thought Hailed as a bipartisan success when passed in late June, two Medicare reform bills are losing some of their luster as they face closer scrutiny by a conference committee made up of members of both chambers charged with reconciling the legislation this fall.
Managed Care August 2000 Bob Carlson	'All Products' Clauses Fade From Physician Contracts All-products provisions in health plan provider contracts are slowly being negotiated, legislated, and regulated out of existence. They are now illegal in at least four states; legislation is pending in several others.
Managed Care July 2000	NCQA To Accredit DM Programs, HEDIS Software The National Committee for Quality Assurance will soon offer its blessing to disease management programs. NCQA is developing a DM certification program intended to recognize regimens that effectively manage chronic illnesses. The program will go live next year.
Managed Care July 2000 Michael Levin-Epstein	Congress Asked To Take Action As HMOs Flee Managed Medicare Thanks mainly to the increasing cost of providing a prescription drug benefit, HMOs are exiting Medicare+Choice, the system that was supposed to manage the health of the nation's senior citizens, in droves. Only an act of Congress can save Medicare+Choice, but is seems doubtful that will happen.
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 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 July 2001 John Otrompke	Stark Allows Federal Regulators To Review Claims Records Fully HMO executives, as well as the providers and physicians who contract with them, should have by now felt the changes in their daily work lives resulting from the government's increased scrutiny of health plans' operations under the fraud-and-abuse compliance laws...
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 April 2005 Frank Diamond	Starting Medicare Advantage Plan Brings Special Set of Problems The feds will help you launch a health plan for the elderly, but just what does it take to get something like this operating in so short a time?
Managed Care August 2005 Maureen Glabman	12 DM Trends You Should Know About The government joins health plans, providers, employers, and pharmaceutical companies in seeking to establish disease management's value
Managed Care April 2002 Frank Diamond	Medicare+Choice: Uncertain Future for Unstable Program While policy makers haggle over President Bush's budget request for the system, an ominous question looms: Can money solve all the problems?
Managed Care August 2006 Frank Diamond	Return to Jackson Hole? The Push for a Standard Benefit A nationwide discussion about making health care available to all Americans gives new life to an old idea.
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 September 2000 John Carroll	Mergers, Acquisitions Afoot In Disease Management Industry Within a few years, there may be only 30 DM companies left, says one expert. HMO customers want vendors to handle more than one condition...
Managed Care April 2000 Michael Levin-Epstein	Congressional Anti-Kickback Battle Hinges on HCFA's Regulatory Stance In an election year, the political hot buttons -- the Patients Bill of Rights and a Medicare prescription benefit, and maybe the issue of medical errors -- are sure to get a lot more attention than such mundane things as laws that would address potential kickbacks....
Managed Care May 2000 Michael Levin-Epstein	Marketing Medicare+Choice? Mind Your Ps and Qs, Says OIG A lot of Medicare HMOs' marketing materials don't cut it, says a report by the Office of the Inspector General. It adds that the Health Care Financing Administration is partly to blame....
Managed Care November 2003 Martin Sipkoff	9 Ways To Reduce Unwarranted Variation Unwarranted variation in medical practice is costly -- and deadly. When the approach in one town is major surgery and in another, it's watchful waiting, you know there's a problem.
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 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 April 2006 Maureen Glabman	'Take My Word for It': The Enduring Dispute Over Measuring DM's Economic Value While disease management is now mainstream, it can still be difficult to judge a program's worth. Health plans faced with renewing these contracts have a lot to think about.
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 August 2001 Frank Diamond	Consumers Dare You to Just Say 'No' The backlash has helped push a Patients' Bill of Rights forward, challenging the very nature of cost containment. Ironically, enrollees may be shortchanged...
Managed Care November 2000	Quality of Care Varies Widely In Fee-for-Service Medicare In what may be the largest known attempt to gauge quality of care in fee-for-service medicine, a Health Care Financing Administration study has found dramatic variance in treatment of Medicare enrollees for six medical conditions...
Managed Care October 2004 John Carroll	DM Industry Jumps for Joy Over Medicare's Leap of Faith The Center for Medicare and Medicaid Services has implemented 10 pilot programs that may very well be viewed as a make-or-break test for disease management.
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 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?
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 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 November 2000 John Carroll	Health Plans Demand Proof That DM Saves Them Money Can disease management vendors really show a strong return on a health plan's investment, or are the data just too malleable to be useful?
Managed Care February 2004 John Carroll	DM Standards Off and Crawling When American Healthways posted a collaborative methodology on its Web site, not everyone in the industry applauded.
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....
Pharmaceutical Executive December 1, 2012 Ben Comer	Top Medical Innovations for 2013 The author profiles 10 innovative technologies designated as new and revolutionary tools for the treatment of disease and disability, such as neuromodulation for cluster and migraine headache.
Managed Care September 2005	New Research Throws Doubt On DM's Cost-Effectiveness Health plans and other providers of disease management services might do better to emphasize the pursuit of better outcomes, rather than guaranteed savings, a new study implies.
Managed Care July 2004	Headlines On Deadline ... In a major victory for HMOs, the Supreme Court voted unanimously on June 21 that patients may not sue health plans in state courts for refusing to pay for medical care recommended by physicians.
Managed Care November 2001	Medicare+Choice Problems Chasing Away 58 Health Plans Medicare+Choice, the program that was supposed to ease the elderly into managed care, is itself suffering from the uneasiness of HMOs dissatisfied with payment rates...