摘要:

A continuum of managed care options has evolved reflecting differing health care market characteristics. Alternative health plans are increasing, outdistancing the “gold standard” staff model HMOs. A dizzying array of options, however, has led to considerable confusion. Direct contracting has evolved as a way for employers to understand what they are paying for and to managed costs. Increases in managed care, and a degree of financial distress, will encourage the development of integrated networks. National reform is unlikely to convert today's loosely structured system to a fully integrated system overnight, but will stimulate managed care in markets sooner than otherwise expected.

ISSN:0148-9917    

出版商:OVID    

年代:1994

数据来源: OVID

摘要:

This article provides both a conceptual overview of pricing health care services and two pricing strategy examples. The overview addresses the underlying concepts of pricing, the factors that influence it, and the risk continuum of pricing approaches. The pricing strategy examples highlight some of the issues and considerations involved in pricing services in a changing health care market. Because the payors of health care will continue to shift economic risk to the providers of health care, the examples emphasize the importance of managing risk.

ISSN:0148-9917    

出版商:OVID    

年代:1994

数据来源: OVID

摘要:

This article explores recent innovative activity by managed care payor plans nationwide with particular emphasis on emerging, new relationships between the plans and their purchasers, enrollees, provider panels, and competitors. Because they already practice what advocates of health care reform are now preaching, many managed care plans are leading the charge to transform our health care delivery and financing systems.

ISSN:0148-9917    

出版商:OVID    

年代:1994

数据来源: OVID

摘要:

This article explores case-mix adjustment systems in the ambulatory care environment as applied by managed care firms. An overview of ambulatory care groupings or ambulatory case-mix systems is given, and the special case-mix adjustment needs of managed care companies are reviewed. Generally, two types of ambulatory care grouping systems are available: encounter-based and population-based. Case examples of three managed care companies that are currently investigating the use of population-based case-mix systems are used to demonstrate the possible use of such systems in the managed care environment such as physician profiling and capitation rate setting.

ISSN:0148-9917    

出版商:OVID    

年代:1994

数据来源: OVID

摘要:

Health care reform, especially if as anticipated via a capitated payment system, will lead providers to integrate the services they provide to the community with those of other organizations. Vertical integration strategies, such as the formation of physician-hospital organizations, and horizontal integration through alliances and holding companies, are the primary vehicles that hospitals and other providers will use to establish integrated networks. By including insurers and primary care physicians in the network and developing information systems to support the delivery of high quality, cost-effective services, the networks can offer a full continuum of care and minimize service duplication.

ISSN:0148-9917    

出版商:OVID    

年代:1994

数据来源: OVID

摘要:

Employers seeking to reduce health care expenditures are turning to direct contracting as a way to control provider cost increases. In a direct contract, the participation of third parties is minimized. The health care provider and a corporate buyer directly negotiate a price agreement for the delivery of health care services. However, as managed care penetration increases, the ability of hospitals and physicians to assume risk while providing high quality, cost effective care will be paramount. Physicians and hospitals who choose to work together may find a physician-hospital organization an effective vehicle to meet the current and future market challenges of direct contracting.

ISSN:0148-9917    

出版商:OVID    

年代:1994

数据来源: OVID

摘要:

This article provides a brief overview of the development of physician networks. The continued progression of managed care and the advent of managed care-based health care reform at the state and national level have escalated the development of physician networks. This article reviews the potential purposes and objectives for forming a physician network as well as the different desired characteristics such as geographic access, network size and composition, and targeted physician characteristics that are important in the network's development.

ISSN:0148-9917    

出版商:OVID    

年代:1994

数据来源: OVID

摘要:

Medicaid spending is an increasing burden on already stressed state budgets. The states find themselves trapped between these growing costs and mounting pressure to ensure access of the underserved to health care services. States are hopeful that managed care is the answer to meeting the seemingly diametric needs of reducing costs while increasing access. However, evidence of performance measured in cost, access, and quality, and financial viability is inconclusive. Nevertheless, there have been some successes and, clearly, Medicaid managed care has potential. The unanswered question is the extent to which states can meet the diverse challenges of both Medicaid and managed care and tap that potential.

ISSN:0148-9917    

出版商:OVID    

年代:1994

数据来源: OVID

ISSN:0148-9917    

出版商:OVID    

年代:1994

数据来源: OVID

摘要:

The article presents the findings from a study of 27 large, multi-specialty medical groups that suggests a new middle range theory that the governance of medical groups is evolving away from professional autonomy due to environmental changes resulting from the expansion of managed care. The article takes a contingency theory approach to the governance of medical groups to determine the locus-of-control for strategic and management decision making. The findings support the contention that successful medical groups limit decision making at the highest level in the organization to a small number of physician leaders, thereby creating a new organizational form, professional oligarchy.

ISSN:0148-9917    

出版商:OVID    

年代:1994

数据来源: OVID