New wording proposed for health plan benefit language
Article Abstract:
A physician and healthcare adviser affiliated with Kaiser Permanente Southern California, David M. Eddy, has proposed that health insurance policy language be changed to promote improvements in health care quality and reduced costs simultaneously. Substituting the phrase 'reasonable and necessary' for 'medically necessary and appropriate' is one example that could help encourage useful interventions and inhibit interventions with little value.
Publication Name: American Medical News
Subject: Health
ISSN: 0001-1843
Year: 1996
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Integration success depends on 'mental model' shift
Article Abstract:
Hospital-physician joint ventures were under development in 1985 and did not succeed because they were an attempt to change the legal structure of the hospital-physician relationship rather than an attempt to establish a common mental model of medical care. Health care professionals discuss medical care in holistic terms but health care systems manage medical care in periodic, temporary episodes.
Publication Name: American Medical News
Subject: Health
ISSN: 0001-1843
Year: 1995
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Medicaid managed care: chaos reigns supreme
Article Abstract:
Transferring Medicaid programs into managed care, as many states including California are doing, should be done in a way that maintains the healthcare systems' efficiency. Instead, many practices have lost their patients and many patients are being displaced from their practitioners and mandated to drive long distances by the default locations assigned by new Medicaid programs.
Publication Name: American Medical News
Subject: Health
ISSN: 0001-1843
Year: 1997
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