Self-funded HMOs: a new managed care hybrid

Article Abstract:

Some US corporations have developed new benefit plans that combine the best features of self-funded programs and health maintenance organization (HMO) services. Companies can realize 8% to 10% savings in overall plan costs during the first year. Self-funded HMOs retain some of the capitated services of a traditional HMO but place other services in the fee-for-service category. The self-funded HMO can be internally linked to the company's indemnity plan. An overview of the benefits and drawbacks of self-funded HMOs is presented.

HEALTH SERVICES, Planning, Services, Employee benefits, Health maintenance organizations

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The managed care value process: creating a successful health care strategy

Article Abstract:

The development of health care strategies by employers requires substantial changes in all aspects of health care management. First, companies should evaluate the pros and cons of their current programs. The value-planning process involving quality and cost should be determined based on value as perceived by both employers and employees. Weighing the major elements of the health plan value is ideally made by setting priorities and objectives.

Methods, Column, Health services administration

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Monitoring physician performance

Article Abstract:

Managed-care companies profile physician performance to ensure health care providers provide high quality medical care at reasonable rates. These companies use patient surveys, claims data and utilization review reports to conduct statistical analyses that can identify improper health care services. Such companies constantly monitor physician provider performance and provide appropriate feedback.

Offices & clinics of medical doctors, Evaluation, Physicians, Medical professions

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