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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.
Managed Care October 2007 John Carroll	Early Tiered Networks Encounter Many Obstacles From dodgy data to uncooperative doctors, difficulties confront health plans that are trying to stratify providers by cost and quality.
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 March 2004 Martin Sipkoff	Can Transparency Save Health Care? If everyone can see what everyone is doing, we'll have better care at lower costs. First task: Create common standards.
Managed Care February 2008 Frank Diamond	Program Lets Patients Rate Doctors Online Regence's effort gets nod of approval from physician organization because it allows providers to respond.
Managed Care May 2004 Martin Sipkoff	Will Pay for Performance Programs Introduce a New Set of Problems? Paying incentives to physicians to practice evidence-based medicine appears to be an idea whose time has come. Such programs -- even if successful -- may create a new set of problems.
Managed Care April 2006 John Carroll	Some Specialist Societies Feel Left Out of AMA-CMS Deal on P4P Many physicians question the fairness of a deal between the American Medical Association and the government that give doctors a bonus when they follow certain rules.
Managed Care March 2004 John Carroll	Narrow Networks' Broader Vision Throughout the late 1990s, the fashion in managed care networks was bigger and bigger. These days, though, health plans around the country have begun sizing up so-called narrow networks once again.
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.
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 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 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 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 July 2005 Martin Sipkoff	Is Pay for Performance Part of the Cure or the Problem? Paying for performance promises improved quality, reduced cost, and higher income for doctors. So why are some of them worried?
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 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.
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 November 2005 Frank Diamond	Physicians and Plans Can Get Along Hill Physicians Medical Group, one of the largest IPAs in the country, has learned to deliver what managed care plans want
Pharmaceutical Executive March 1, 2007 Jeffrey Zornitsky	Sales Management: Get Committed By better managing relationships with physicians, pharma companies can develop a base of dedicated prescribers.
Managed Care March 2002	6 Large California Plans Link Doc Bonuses, Quality In what's being touted as an unprecedented effort, doctors and hospitals in California will be rewarded with bonuses of at least 5 percent for quality under a common set of standards adopted by six HMOs...
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.
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	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.
CFO February 1, 2007 Karen M. Kroll	Pin the Tail on the Doctor A dearth of information leaves health-care consumers in the dark. As health-care information becomes more accessible, will employees use it to purchase health-care services more intelligently?
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 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 May 2007 Lola Butcher	Massive Databases Under Construction Insurers and employers are busily compiling databases to control costs and improve care, but physicians are laying claim to the data.
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 May 2003	Program Rewards Physicians For Delivering High-Quality Care Bonuses for delivering high quality care will be the focus of a three-market program spearheaded by the National Committee for Quality Assurance and supported by a coalition of physicians, health plans, large employers, and the Centers for Medicare and Medicaid Services.
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 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....
Pharmaceutical Executive January 1, 2007 Jeffrey Zornitsky	Sales Management: Get Committed By better managing relationships with physicians, pharma companies can develop a base of dedicated prescribers.
Pharmaceutical Executive September 1, 2013 Shantanu Agrawal	Making Sense of the Sunshine Act: A New Era for Drug Promotion Now that the Sunshine Act's Open Payments spending disclosure program is live, the federal government's lead officer for compliance explains how the new web-based system will work and how US industry, providers, and patients will be better off by making their relationships fully transparent.
Managed Care November 2003 John Carroll	"Concierge Care" by Any Name Raises Ethical Concerns Medical directors at managed care organizations have been hard-pressed to come to a consensus on just how -- or whether -- this new wrinkle in the managed care business fits in.
Managed Care December 2006	NCQA Rankings Give Edge to Not-For-Profit Insurers No sooner had the quality rankings of health plans in the nation, as measured by the National Committee for Quality Assurance, been released then it was pointed out that most of the top performers were not-for-profit insurers.
Managed Care October 2005 MargaretAnn Cross	Just How Will CDHC Change Your Job? Medical directors are charged with many of the tasks that could help members make the most of consumer-directed health plans.
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 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 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 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.
BusinessWeek April 23, 2009 Catherine Arnst	Doctors' Pride: A Hurdle to Digital Medicine A forerunner in New England found that some physicians would sooner cut ties than see their elite status threatened.
Managed Care December 2002 MargaretAnn Cross	Advisory Boards Create Company-Plan Cooperation Very effective if used properly, these panels are not yet widespread. However, that could change as industrial customers demand more input.
Managed Care April 2004 Martin Sipkoff	Plans Go Directly to Patients, Describing Treatment Options HMOs are developing programs that encourage patients to question their physicians about their treatment options. Doctors are wary.
Insurance & Technology December 13, 2006 Anthony O'Donnell	New World Record Built on the CareEngine technology platform developed by Aetna subsidiary ActiveHealth Management, PHR gives members online access to personal health information.
Managed Care April 2005 Martin Sipkoff	Health Plans, Employers Join Forces To Promote E-Prescribing The e-prescribing movement is getting some new advocates --employers. Can the combined influence of plans, employers, and the government affect physician buy-in?
The Motley Fool February 14, 2008 Rich Smith	Great Spitzer's Ghost! New York State Attorney General Andrew Cuomo promises to sue UnitedHealth as part of a wide-ranging investigation into alleged collusion and fraud pervading the health insurance industry.
Managed Care January 2007	Headlines on Deadline ... State budgets got an unexpected gift last year... Mortality rates for hospitals ranked high... It looks likely that Massachusetts Gov. Mitt Romney will run for president... etc.
InternetNews April 29, 2004 Susan Kuchinskas	Health Could Mean Wealth for Microsoft A partnership with WellPoint Health Networks aims to persuade doctors to go wireless on PocketPCs.
The Motley Fool March 7, 2008 Brian Orelli	Insurers' Tarnished Reputations Shine Find out which ones rank lowest and why it doesn't matter.
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...