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Biomedical subjects

P Nathanson

Publications and source records attributed to P Nathanson.

15 recordsLinked to original sources
PubMed1997

Profiling primary care physicians for a new managed care network.

We developed methods for comparing physicians who would be selected to participate in a major employer's self-insurance program. These methods used insurance claims data to identify and profile physicians according to deviations from prevailing practice and outcome patterns, after considering differences in case-mix and severity of illness among the patients treated by those providers. The discussion notes the usefulness and limitations of claims data for this and other purposes. We also comment on policy implications and the relationships between our methods and health care reform strategies designed to influence overall health care costs.

Ambulatory Care↗
PubMed1995

Behind closed doors.

Wouldn't you like to know what the executives at other health systems in your market are thinking--and saying--behind closed doors, as they prepare their strategic game plan for managed care? We certainly would, so we asked a leading expert in the field to re-create--docudrama style--what goes on once the conference doors shut and the hard work begins.

Decision Making, Organizational↗
PubMed1994

CEO summit. The new delivery & financing realities. Part III of III.

In cooperation with McManis Associates Inc., Washington, Hospitals & Health Networks recently convened a summit on the integration of financing and delivery in health care. This installment is the third of a three-part series on lessons learned by those on the front lines of integration activity. The session was designed and facilitated by senior associates at McManis. Among the issues summit participants discussed in the second segment: What level of understanding do purchasers have of the factors that differentiate quality in health care services? Can provider-driven integrated delivery systems compete with insurer-driven ones? And what happens when a large integrated delivery system merges with a dominant insurer, as happened in the Philadelphia market? Can that model be successfully replicated in other markets? In this final segment, participants talk about whether providers' deep connections to their communities will add value in a reformed delivery system; how incentives might be aligned among all the players in integrated networks and organizations; how the concept of community focus might be redefined under systems integration; and the process involved in preparing for constant, accelerated change. The second segment concluded with comments about the assets providers and insurers bring to integrated health systems, and whether the merger experience of Graduate Health System and QCC/Independence Blue Cross could be replicated in other markets or not.

Community-Institutional Relations↗
PubMed1994

CEO summit. The new delivery & financing realities. Part II of III.

In cooperation with McManis Associates Inc., Hospitals & Health Networks recently convened a summit on the integration of financing and delivery in health care. This is the second of a three-part series on lessons learned by those on the front lines of integration activity. The session was designed and facilitated by senior associates at McManis. Among the issues discussed in this second segment. What level of understanding do purchasers have of quality differentiators in health care services? Can provider-driven integrated delivery systems compete with insurer-driven ones? And what happens when, as in the Philadelphia market, a large integrated delivery system merges with a dominant insurer? Can that model be replicated in other markets?

Comprehensive Health Care↗
PubMed1994

CEO summit. The new delivery & financing realities. Part I of III.

In cooperation with McManis Associates Inc., Hospitals & Health Networks recently convened a summit on the integration of financing and delivery of health care. This report is the first of a three-part series on lessons learned by those on the front lines of integration activity. The session was designed and facilitated by senior associates at McManis. Among the issues discussed in this first segment: Is integration necessary to satisfy the demands of health care payers? Is integration the way to cost-containment? How can costs be squeezed out of the system? What relationship will physicians have to hospitals and insurers in integrated systems?

Chief Executive Officers, Hospital↗
PubMed1994

Using claims data to select primary care physicians for a managed care network.

An insurance claims databased profiling system was developed to help select new primary care physicians (PCPs) for a managed care network. PCPs (family practitioners, internists, and pediatricians) were ranked based on how closely their actual use of outpatient services conformed to the predictions of a mathematical model that adjusted for differences in age, sex, and case mix.

Ambulatory Care↗
PubMed1994

Influencing physician practice patterns.

Today, customers are holding hospitals accountable for improving clinical outcomes and cost containment in ways that require the cooperation and collaboration of physicians. This chapter examines four strategies for influencing physician practice patterns: financial risk sharing, utilization management, performance feedback, and continuous quality improvement/total quality management (CQI/TQM). The strengths and weaknesses of each strategy are explored, along with real-life examples of how each has been successfully applied.

Clinical Competence↗
PubMed1993

Total quality management: rhetoric and reality.

TQM in health care today is still more rhetoric than reality. Changing the typical health care organization's culture and installing the infrastructure needed to support TQM will be expensive and time consuming, and will require a new technology of health care quality control that is still developing. TQM will achieve its considerable potential only if management stays the course, invests the time and money--and reins in Ruby and her ilk.

Cardiology Service, Hospital↗
PubMed1989

Measuring and marketing quality: how to start.

Growing armies of consultants, hardware and software vendors and severity system entrepreneurs are ready to help with whatever tools and approaches you think you need to evaluate, upgrade and publicize your hospital's quality. But buyers should beware. None of these tools will help if your hospital's culture and climate aren't ready to accept them.

Attitude of Health Personnel↗