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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 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 May 2000	Arizona Nixes Doc Incentives, OKs Plan Liability The publicity given to the Texas attorney general's agreement with Aetna overshadowed a more sweeping edict in Arizona regarding financial incentives to physicians....
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 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 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 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 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 February 2007	Quality is Important, But Productivity Rules Despite a rise in the use of quality incentives to determine physician compensation, productivity remains the predominant determinant.
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 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 December 2006	Compensation Monitor More than half of the nation's HMOs use pay-for-performance programs.
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 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 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 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 January 2006	Compensation Monitor A recent poll reveals that doctors distrust pay for performance programs.
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 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 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 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 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 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.
Managed Care August 2006	Put Away That Carrot and Stick Researchers interviewed practice managers about how financial incentives are implemented in physician practices and the attitudes and perceptions they had toward P4P programs.
Managed Care February 2005	Class-Action Suit By 600,000 Docs Heading To Court Discusses a lawsuit filed by about 600,000 physicians against some of the biggest health plans in the country: Humana, PacifiCare, UnitedHealthcare, WellPoint, Anthem, and Health Net. Aetna and Cigna were named but settled out of court.
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 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 2007	Physicians Oppose Public Disclosure of Quality Although 3 out of 4 primary care physicians support the use of financial rewards as an incentive for better medical care, the majority would rather not make quality assessments readily available to the public, according to a recent survey.
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 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...
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 2003	Electronic prescribing has no effect on formulary compliance A retrospective analysis of claims data from Aetna indicates that systems that allow physicians to enter prescriptions electronically on a handheld device that also provides drug information and formulary status have no significant effect on compliance with formularies and utilization of generics.
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 2006 Arthur Lazarus	Expert Opinions Create Liability for Physicians Physicians cannot rely on courts, drug companies, or HMOs to protect their freedom of speech. Their experience and knowledge form the foundation of all medical opinion.
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 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 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 April 2002	Ruling Makes Class-Action Suit More Plausible The idea of a class-action lawsuit against HMOs was boosted by a recent decision in a federal court in Florida. Meanwhile, the Blue Cross and Blue Shield Association has sounded the alarm that efforts to increase health plan liability may be launched in at least eight states...
Managed Care May 2000	Physicians Fudge Insurance Forms To Help Patients A study confirms what has long been considered common but is rarely discussed: Physicians often lie about patients' conditions to gain or improve coverage for their treatment.
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.
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 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 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 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 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 August 2001	Interest in capitation backs off More than half of provider organizations surveyed by Evergreen Re, a national reinsurance consultant and broker, had at least one capitation contract last year -- but use of capitation fell dramatically from 1999 to 2000..
Insurance & Technology December 6, 2007 Nathan Conz	Aetna, CIGNA, Empire BlueCross Establish Standards With New York State AG The health insurers have reached an agreement with the New York State Attorney General on standards for physician-rating programs.
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 July 2002	Money isn't everything Physicians are fairly happy with their incomes, but unhappy with the number of hours they have to work, as well as with the ancillary duties involved in practicing medicine, according to a survey.
Managed Care July 2003 Ed Silverman	A Little Something For the Physicians Health plans know that getting along with physicians is important, and many are trying new initiatives. Here are some successes.