Direct provider contracting: one employer's experience

Article Abstract:

The experience of a large employer based in the Midwest demonstrates the feasibility of contracting directly with an integrated delivery system (IDS) to provide medical benefits to employees. The company's decision to resort to direct provider contracting was prompted by a change in employee contribution strategy and an evaluation of anticipated health maintenance organization premiums. The IDS was chosen on the basis of operational capabilities, health care management, financial stability, marketing, organizational structure and a host of other factors. Contracting with the IDS enabled the employer to significantly reduce cost without changing its existing managed care network.

Employee Benefits NEC, Management, Contracts, Medical care, Cost of, Health care costs, Employee benefits

---

Assignability of health/welfare benefits; Standing to sue

Article Abstract:

A health care provider enjoys derivative standing to file suit for benefits under ERISA when it is the assignee of a beneficiary's rights to benefits because it stands in the shoes of the beneficiary. Although ERISA prohibits the assignment of pension benefits, it allows the assignment of health benefits since such assignments facilitate the payment of those benefits. Parties may contract for nonassignable health benefits, however, and where they do, the assignment will be given effect and a medical provider will be precluded from obtaining those benefits. Article includes City of Hope Nat. Medical Ctr. v. Healthplus, Inc. case.

United States, Cases, Health care industry, Actions and defenses, Litigation, City of Hope National Medical Center (Duarte, California), HealthPlus of Michigan Inc.

---

Understanding managed care risk sharing arrangements

Article Abstract:

Managed care risk sharing contracts are financial guarantees from managed care organizations that their programs will effect savings for managing employers medical claims. Employers should be aware of the elements that affect target claims and how target claims are identified to avoid problems caused by the savings quantification and actuarial pricing issues involved in such agreements.

Risk assessment

Similar abstracts:

• Abstracts: One size does not fit all: managing IT employees' employment arrangements. When executives influence peers: does function matter?
• Abstracts: In defence of active management. Global investment risk management. Fund managers begin to come clean
• Abstracts: Expatriate selection, training and career-pathing: a review and critique. Expatriate Training and Development: Where Do We Go From Here?
• Abstracts: A revolution in First Aid training. Interactive training on display screen equipment requirements. Learning lifting: LOLER 98 explained
• Abstracts: ERISA plan vs. payroll practice-Preemption. Postdeath QDRO - de novo standard of review - preretirement survivor benefit - attorney fees

This website is not affiliated with document authors or copyright owners. This page is provided for informational purposes only. Unintentional errors are possible.