Today's managed care market
Article Abstract:
Many health maintenance organizations (HMOs) depend on their primary care physicians (PCP) in managing the volume and intensity of medical care. Studies show that PCPs could be the major care provider in attending to 70% of all cases for individuals below 65. PCPs play a minor role in treating less prevalent medical conditions. There is doubt of whether PCPs can influence the overall treatment pattern after patient referral. HMOs must come up with other management techniques to control in medical care costs.
Publication Name: Compensation & Benefits Management
Subject: Insurance
ISSN: 0748-061X
Year: 1995
User Contributions:
Comment about this article or add new information about this topic:
Today's managed care market: characteristics needed for vertically integrated health systems to deliver efficient medical services
Article Abstract:
Physicians can maintain their patient base and compete against health maintenance organizations (HMOs) by establishing alliances with physician groups and hospitals. At present, more than 650 such alliances, also known as vertically-integrated health systems have been organized. These health systems have more than 100 physicians in their groups and they have full-risk capitation agreements with HMOs. A system by which integrated health systems can efficiently deliver medical services is described.
Publication Name: Compensation & Benefits Management
Subject: Insurance
ISSN: 0748-061X
Year: 1995
User Contributions:
Comment about this article or add new information about this topic:
Today's managed care market
Article Abstract:
Physician groups can increase profits derived from group medical practice by using accurate International Classification of Disease, 9th Revision (ICD.9)-coded information. First, ICD.9 codes are used to formulate patient-specific capitation rates. Second, they are utilized to compensate doctors for quality and cost efficient care. Third, risk-adjustment systems can be created and fourth, the right composition and number of doctors can be hired.
Publication Name: Compensation & Benefits Management
Subject: Insurance
ISSN: 0748-061X
Year: 1996
User Contributions:
Comment about this article or add new information about this topic:
- Abstracts: Today's managed care market: benchmark results for medical care guidelines, part II. Today's managed care market: utilizing quantitative data to understand asthma treatment patterns
- Abstracts: Fear and loathing Form 5500. HIPAA: compliance issues for group health plans. The quality health care coalition act of 1999
- Abstracts: Managing retiree medical costs: responding to FAS 106. Integrated disability/medical management. Options for reducing retiree medical expenses
- Abstracts: Today's pension retirement plan leaves much for concern. Formal plan documents control over SPD. No breach of fiduciary where plan had substantial surplus
- Abstracts: Global challenges face middle market brokers. Specialty programs offer survival niche for agents. Brokers caught in vise must adapt to survive