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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 2006	Compensation Monitor More than half of the nation's HMOs use pay-for-performance programs.
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 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 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 July 2006	Physicians' Real Income Continues to Fall Adjusted for inflation, physicians' net income from the practice of medicine declined 7% between 1995 and 2003, according to a national study.
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 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 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 February 2002	Industry Braces for Fallout From Docs' Malpractice Woes Malpractice insurance premiums are going up so quickly that many physicians are feeling pressure to stop offering certain procedures, to move to states that are friendlier to medical practices, or even to retire early...
Managed Care April 2000	Physician payment may hinge on quality, not quantity, in 2010 The Institute for the Future, a not-for-profit research group, suggests that over the next 10 years, performance-based payment mechanisms will gain popularity....
Managed Care June 2006	Fewer Doctors Contract with Managed Care Although it was stable in the mid-1990s, the proportion of physicians without any managed care contracts rose from 9.2 percent in 2000-2001 to 11.5 percent in 2004-2005, according to a report.
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 October 2005	Salary Slowdown Reported for Specialists Compensation growth for specialists fell behind that of primary care physicians in 2004 for the first time in several years, according to a survey.
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 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 November 2006	Compensation Monitor Doctors say they're busy but underpaid.
Managed Care March 2001	Physician income trends vary by specialty In tracking the salaries of primary care physicians and specialists over a decade, the Medical Group Management Association has documented similarities and differences in trends based on specialty...
Managed Care January 2005	Headlines on Deadline... More on the pay-for-performance push... The nation's HMOs operated on a slim profit margin in the first three months of 2004... Health coverage is not a factor in determining the level of care children receive in the U.S... etc.
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 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 April 2002	What's An E-Mail Consultation Worth? The answer depends on whom you ask. A search of news archives turns up two reported experiments with reimbursement of physicians for e-mail communication with patients...
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.
Managed Care July 2006	Physician Satisfaction Study Surprises A new study suggests that physicians working in areas where there is an extensive medical infrastructure are less happy with the quality of the care they provide than doctors working elsewhere.
Managed Care October 2007	Family Physicians Give Payers Middling Grades Results of a survey conducted by the American Academy of Family Physicians and Family Practice Management magazine indicate that health plans have issues to work on.
Managed Care May 2006	Physician Disclosure Strengthens Patients' Trust Patients who received a disclosure felt more competent to judge the effect of their physician's compensation on their health care, and nearly a quarter of patients who remembered receiving a disclosure reported that it had increased their trust in their primary care physician.
Managed Care January 2007	Change From Salary to Relative Value Units Leads to Higher Income for Physicians A Minnesota medical group that contracted with HealthPartners was able to improve cost of care, physician compensation, and patient access without harming patient satisfaction when the group converted from a salary payment system for physicians to one solely dependent on physician productivity.
Managed Care December 2002	Providers turn to fee-for-service charges to make up revenue lost under capitation If there's any doubt whether capitation has left a bit of a sour taste in the mouths of physicians and hospitals, a survey issued earlier this year would seem to confirm it.
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 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 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 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 September 2000	Capitation: How well is your back covered? Make no mistake: Capitation--despite the beating its reputation has taken of late---isn't out of fashion. In fact, its prevalence is increasing, with 14 percent more physician groups having some involvement in capitation last year than in 1998...
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 July 2007 Tom Reinke	Better Ways to Pay Providers Paying for coordinating care and for packages of services -- bundling and episodes of care -- may be the best bet for a modification of the unfettered fee-for-service system.
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 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 July 1, 2011 Cabacungan & Clark	New Ways to Gain New Brand Insights If you can learn to understand patient and physician behavior, you are well on your way to strengthening the position of your product.
Managed Care December 2000	While Large HMOs' Finances Improve, Small Plans Suffer Several large MCOs, including WellPoint, Cigna, United Healthcare, and Oxford, have reported strong third-quarter earnings. However, 44 percent of HMOs reported losses, a large proportion of those being plans with fewer than 100,000 members...
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 June 2004	Providers Retain Upper Hand Over Health Plans Hospitals in recent years have been successful in getting higher rates, decreasing their exposure to risk and obtaining other advantageous contract provisions from health plans, according to a new study.
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 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 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 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 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 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 January 2002 Ed Rabinowitz	When Physicians' Skills Fail, Collaboration Beats Punishment New programs hold promise for rehabilitating sound physicians who have, for any number of reasons, lost some of the skills they started with...
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.