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PubMedDate not supplied

Case management for the self-insured hospital.

It is rare for employers who self insure to have on-site case management. Generally, self-insured employers rely on the third-party-plan administrators to control health care costs, provide enrollees with health care benefit management services, and maintain customer satisfaction. In this article, the author discusses the internal workings of an employee case management program implemented in a self-insured hospital in Northwest Indiana. Information is presented on the goals and role of the case manager, scope of practice, barriers to the program, and resources involved to deliver health care services to its enrollees. Also presented is pertinent information to track and trend data for administrative reports. In addition, customer satisfaction and the value of an on-site case manager for self-insured organizations will be addressed. The results demonstrate a reduction in the volume of inpatient admissions, length of stay, and, therefore, an improved use of the health plan.

Case Management↗
PubMed1979

Benefits of self-insured hospitalization programs.

As part of hospitals' continuing efforts to control costs, many have begun to consider implementing self-insured hospitalization programs for their employees. Not only can self-insurance provide cash flow savings and actual cost savings but it can also promote prevention among hospital employees.

Accounts Payable and Receivable↗
PubMed1987

Actuarial status of the HI (hospital insurance) and SMI (supplementary medical insurance) Trust Funds.

This article is adapted from the 1987 Annual Reports of the Medicare Board of Trustees. It presents a summary of the current financial and actuarial status of the Hospital Insurance (HI) and Supplementary Medical Insurance (SMI) Trust Funds. The Board found that the present financing schedule for the HI program is sufficient to ensure the payment of benefits over the next 12-14 years if the intermediate (II-A and II-B) assumptions underlying the estimates are realized. Although steps have been undertaken to reduce the rate of growth in payments to hospitals, the Board urges Congress to take remedial measures to bring future HI program costs and financing into balance. The Board found the SMI program to be actuarially sound but recommends that Congress take action to curtail the rapid growth in that part of Medicare.

Financing, Organized↗
PubMed1997

Hospital-insurer bargaining: an empirical investigation of appendectomy pricing.

Employers' increased sensitivity to health care costs has forced insurers to seek ways to lower costs through effective bargaining with providers. What factors determine the prices negotiated between hospitals and insurers? The hospital-insurer interaction is captured in the context of a bargaining model, in which the gains from bargaining are explicitly defined. Appendectomy was chosen because it is a well-defined procedure with little clinical variation. Our results show that certain hospital institutional arrangements (e.g. hospital affiliations), HMO penetration, and greater hospital concentration improve hospitals' bargaining position. Furthermore, hospitals' bargaining effectiveness has diminished over time and varies across states.

Appendectomy↗
PubMed1988

Medicare program; hospital insurance entitlement and supplementary medical insurance enrollment and entitlement--HCFA. Final rule.

These regulations amend the Medicare rules that deal with hospital insurance entitlement and with supplementary medical insurance (SMI) enrollment and entitlement. They also revise rules and deal with State buy-in agreements, that is, agreements under which States may secure SMI benefits for certain Medicaid-eligible individuals by enrolling them in SMI and paying their SMI premiums. The changes are necessary to conform our rules to changes made in the Medicare and Medicaid laws since the rules were last published. The purpose is to ensure that those who must apply our rules are not misled or confused by content that fails to reflect statutory changes and modified policy.

Centers for Medicare and Medicaid Services, U.S.↗
PubMed1983

Actuarial status of the Hospital Insurance and Supplementary Medical Insurance Trust Funds.

This article, adapted from a summary of the 1983 Annual Reports of the Medicare Boards of Trustees, presents the present and projected future actuarial status of the Hospital Insurance (HI) and Supplementary Medical Insurance (SMI) Trust Funds following the enactment of the Tax Equity and Fiscal Responsibility Act of 1982 and the Social Security Amendments of 1983. Although the Trustees characterize the outlook for the HI Trust Fund as slightly more optimistic than it was a year earlier, they report that the fund may be exhausted sometime between 1988 and 1996 unless benefits under the HI part of Medicare are reduced or financing is improved. The SMI Trust Fund, which is financed by premiums adjusted each year to reflect actual experience and by general revenue contributions, is characterized as actuarially sound. The Trustees note, however, the growing extent to which general revenue financing is becoming the major source of income for the SMI part of Medicare.

Costs and Cost Analysis↗