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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 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 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 2000	Changing physicians: Why they do it More than 1 in 8 people changed their personal physician or other primary provider of health care last year. For people enrolled in HMOs, quality of care -- not something related to coverage -- was the number one impetus for switching providers.
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?...
AskMen.com Brantley Oakey	Best Health Insurance Plans While health-care costs won't stop rising, we can curb our spending. Here is a list of the five best health insurance plans for single men based on best value.
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	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 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 December 2006	Compensation Monitor More than half of the nation's HMOs use pay-for-performance programs.
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 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 Richard Hamer	Goals 2000: For HMOs: Administrative Retooling For MDs: Managerial Competency ...While HMOs retrench, physicians need to become more constructive participants....
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 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 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....
Pharmaceutical Executive March 1, 2013 Al Topin	Less Selling, More Time What can happen when pharmaceutical reps focus on the physician-patient conversation?
Managed Care May 2001	Demand's cool for primary care physicians Although they're not quite an endangered species, primary care physicians aren't exactly in high demand these days, either. That's been the experience of a national physician search and recruitment firm...
Managed Care May 2002 Ernest P. Schloss	Estimating Pediatric Primary Care Provider Visits In a Capitated Environment: Encounter vs. Claims Databases Encounter databases capture more information about PCP visits than insurance claims databases in capitated environments
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 September 2003	Primary care pay falls again Primary care physicians' compensation continues to decline, according to the American Medical Group Association's 2003 Medical Group Compensation and Productivity survey.
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 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.
AskMen.com April 15, 2001 Joshua Levine	Choosing The Right Doctor Choosing a doctor is one of the most important decisions you can make. It's probably best made when you are healthy and have some time to think about a number of possibilities. If you don't have a doctor or are thinking about changing doctors, now may be the best time to look...
Managed Care October 2007	Managed Care Outlook Medical costs, utilization rates decline again.
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 January 2004	Opportunities abound for physician executives Physician executives who are considering leaving management positions in managed care organizations should look to greener pastures at practice management companies, medical/health care associations, health system corporate offices, and foundations.
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 2001 Richard B. Dwore	Study An Opportunity for HMOs To Use Marketing To Increase Enrollee Satisfaction...
Managed Care January 2005	Private Practice Physicians Find Dual Role Challenging When it comes to balancing the role of business owner and practicing physician, many private practice doctors are having a tough time of it.
Managed Care June 2002	Report: Physicians storm Web sites to get information on formularies A study shows a big increase over the course of a year in the number of physician hits on HMO sites to get information on claims status, clinical guidelines, and many other topics.
Managed Care December 2000	Headlines on Deadline... Physician fees under Medicare will go up an average of 4.5 percent next year... The number of HMOs participating in the Federal Employees Health Benefits Plan dropped by 40 percent... The California Public Employees' Retirement System has seen a 40-percent increase in medical costs... etc.
Managed Care October 2003 MargaretAnn Cross	Some HMOs See Dividends In Charging Deductibles This may be one way to regain profitability, though getting permission from government regulators may take some doing.
Pharmaceutical Executive January 1, 2013 Al Topin	The Doctor-Patient Disconnect Doctor-patient conversations aren't always what we think; this basic interaction represents both a problem and an opportunity for today's drug marketers, says the author.
Managed Care October 2001	Physician Pay Used as Boost For Quality Momentum is building to use physician reimbursement and bonuses not just as utilization controls, but as quality-improvement tools...
Pharmaceutical Executive September 1, 2012 Al Topin	Doctors' Words No Longer Gospel In the digital age, physicians don't call the shots when it comes to healthcare guidance. Marketers must appeal to multiple sources in seeking ways to garner patient adherence and loyalty.
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 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 January 2008	Emerging Role for New Niche Specialists New physician specialists like laborists, surgicalists, and nocturnists are beginning to fill specific niches in the provider market.
Managed Care September 2000	Key Texas Lawsuit Against HMO Now Off Court Docket The first lawsuit against an HMO under Texas's health plan liability statute has been settled...
Managed Care July 2007	Managed Care Outlook The future holds too few docs.
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 2002 Jeffry R. Ellis	Third-Party Payers Don't Realize Burdens Placed on Pharmacists PBMs and HMOs, by imposing a workload that doesn't allow enough time for needed functions, seem to want pharmacists to fail, this author asserts.
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 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 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 October 2004	Does Payment Method Drive Procedure Rates? In a study involving three large HMOs, researchers reviewed encounter and claim data for specialty services associated with different rates of performance of invasive procedures.
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...
CRM April 13, 2015	Evariant Releases New Version of CRM Platform and Applications Newest offerings include contact center solution for real-time engagement with patients and providers and mobile Physician Relationship Management app.
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....