Reinventing your health plan service relationship

Article Abstract:

A relationship review between the health care provider and the plan sponsor is needed to avert further complications in health care services delivery to employees. The health care industry is undergoing changes that diminishes its capability to provide timely and appropriate service, to the chagrin of plan sponsors. But sponsors and their health care providers must view their relationship similar to that with business customers, so that a meeting of expectations and resources can be effected.

Employee Benefits & Services, Management, Human resource management

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Health care quality: a primer for plan sponsors

Article Abstract:

Employers sponsoring health plans for their employees should evaluate the plan in terms of structure, delivery and effectivity of outcome. One assurance of a health plan's performance credibility is if it possesses accreditation from the Joint Commission for Accreditation of Health Organizations and the National Committee for Quality Assurance. Sponsors should also measure reliability in processes such as claim adjudication, secular trend rates and implementation of a network program.

Direct Health and Medical Insurance Carriers, Hospital and medical service plans, Medical Care Insurance, Analysis

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Should plan sponsors be reviewing managed care delivery?

Article Abstract:

Site visits and clinical assessments of Health Maintenance Organizations (HMO) and Managed Care Organizations (MCO) by plan sponsors provide first-hand information of the quality of care delivered and help minimize plan liabilities. The six key areas of HMO/MCO operations that site visits focus on include leadership, organizational and motivational framework, clinical practices, quality, results and measurement systems.

Health Maintenance Organizations, HMO Medical Centers, Health aspects, Evaluation, Services, Workers

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