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Results for “Managed Competition”

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At least 559 records · Page 31Linked to original sources
PubMed1997

Action steps to prepare for the new managed care.

Remaining competitive under a managed care system requires skills and talents that were not necessarily important in home care until recent years. And as we get used to it, the current managed care model will undergo even more disruptions in the near future. Providers that want to succeed in the 21st century must learn to adapt and re-adapt to the managed care of tomorrow.

Administrative Personnel↗
PubMed2005

The effects of case mix on hospital costs and revenues in managed care environments.

Due to competition and managed care, hospitals have argued that the rate of increase in hospital cost is greater than the rate of increase in hospital revenue. It is important to pay hospitals based on the expected resource use of patients that hospitals treat. However, managed care organizations pay hospitals based on negotiated prices that do not consider the expected resource use of patients. The purpose of this paper is to provide a better understanding of those factors affecting hospital cost and revenue in California using the hospital financial and utilization data for selected years from 1986 to 1998. By developing case mix indexes (CMIs) using all hospital discharges in California, this study found that the coefficients for CMIs in total and inpatient hospital revenue models were greater than those in hospital cost models. Over time, however, the differences in coefficients for CMIs in hospital revenue and cost models become smaller and smaller. Thus, this study shows that the difference between hospital revenues and hospital costs, looking at hospital case mix, has decreased, although hospital revenues are still greater than hospital costs.

California↗
PubMed1981

The competitive approach to health care reform: implications for hospital management.

A successful competitive approach to health care reform based on the development of prepaid health care plans could affect hospital management. From hospital management's point of view, affiliations with health care plans have advantages and disadvantages. Since hospitals cannot remain unaffected by health care plan development in their market areas, they must choose their affiliations to be consistent with their own institutional objectives.

Contract Services↗
PubMed1996

Establishing a competitive advantage through quality management.

The successful dentist of the future will establish a sustainable competitive advantage in the marketplace by recognising that patients undergoing dental treatment cannot see the result before purchase, and that they therefore look for signs of service quality to reduce uncertainty. Thus the successful dentist will implement a quality programme that recognises not only that quality is defined by meeting patients' needs and expectations, but also that quality service is fundamental to successful business strategy. Finally, the successful dentist of the future will realise that the pursuit of quality is a never-ending process which requires leadership by example.

Dental Staff↗
PubMed1998

Lessons learned in managed care.

Competition, reduction in health care premiums, rising health care costs, aging of the population, and technologic advances are several factors that create both challenges and opportunities for managed care organizations (MCOs). The demands to constantly improve quality of care and efficiency of operation while holding down costs are drivers meant to stimulate organizations to constantly strive to rethink their process of care provision. The most cost-effective program is one that maintains its health plan members who are active in the community and away from the institutional setting. This is optimally achieved through an accessible and comprehensive ambulatory practice. Innovation and paradigms of practice change in the acute, subacute, and long-term care arenas have allowed us to dramatically impact quality and utilization in these expensive areas, while at the same time freeing up additional time for MCO primary care practitioners to focus on their community-based patients. MCO primary care providers have not only supported but welcomed these changes in their organization, recognizing that these innovations represent a component of the continuum of health care needed to effectively serve their patients.

Aged↗
PubMed2006

Synergy between Competitive Intelligence (CI), Knowledge Management (KM) and Technological Foresight (TF) as a strategic model of prospecting--the use of biotechnology in the development of drugs against breast cancer.

The aim of this paper is to demonstrate the synergy between Competitive Intelligence, Knowledge Management and Technological Foresight, and to emphasize the proposal of a strategic model of data prospecting as a mechanism to support decision-making in regard to three approaches for sustainable development and innovation: technological, social and economic. The use of biotechnology in the development of drugs against breast cancer is the case study. The article shows the results of data and text mining in specialized medical and patent databases, identifying the most frequently cited drugs, as well as the authors of research, and the inventors of new technology at the beginning of the 21st century. In addition, the study includes reference to Brazilian competence in breast cancer area, the international trends in drugs for treatment of this cancer, leading international institutions and Brazilian competencies. A framework is presented, which could serve as a guide and support for the decision-making process.

Biotechnology↗
PubMed1998

Competition through physician-managed care: the case for capitated multispecialty group practices.

The dominant managed care model in the USA is the individual practice association (IPA), in which physicians in separate practices contract with a health plan. One alternative model, the capitated multispecialty group practice (CMGP), has some distinct advantages: (i) the best randomized trial comparing a health management organization (HMO) with indemnity insurance showed equivalent health outcomes for a prepaid group-practice model HMO, with about a 40% saving in cost, mostly from lower hospital utilization. There is no comparable evidence for IPA-style HMO's; (ii) most managed care plans control costs through 'gatekeeper' primary care physicians or capitated payment. Strong financial disincentives to care, applied to small practices, lead to a significant risk of withholding needed care. Large capitated groups diffuse the risk among hundreds or thousands of physicians; (iii) small practices also lack the financial resources and expertise to develop information systems, continuous quality improvement programs, and other means of improving efficiency. Larger groups can integrate specialty and primary care, laboratory, pharmacy, information technology and other services, to improve quality and cost-effectiveness, while maintaining physician control of the process; (iv) in urban California, HMO enrollment in six large capitated groups increased by 91% from 1990 to 1994. Hospital utilization for these groups was less than half the USA average; (v) because it is self-insured, the CMGP could contract directly with purchasers, eliminating the need for the insurance intermediary. The CGMP offers an ethical, effective alternative that maintains the primacy of the physician in health care: physician-managed care.

California↗
PubMed1994

[Quality management between science and competition].

The call for an increase in quality assurance becomes louder and louder. However, it is almost always understood as a more intensive monitoring of quality. The ideas of total quality management described in the ISO norms 9000-9004 gain ground only slowly. By defining quality indicators and developing practical guidelines or appropriate methods of quality management, science could provide the basis. Information processing can make essential contributions such as the profiles of the German perinatal surveys or the Swiss gynecological-obstetrical quality statistics developed by Hochuli et al., but the only way to a widely applied total quality management is quality-assuring activities and quality becoming factors of competition themselves.

Competitive Medical Plans↗
PubMed2006

The impacts of different management strategies and environmental forcing in ecological communities.

Understanding the effects of population management on the community a target species belongs to is of key importance for successful management. It is known that the removal or extinction of a single species in a community may lead to extinctions of other community members. In our study, we assess the impacts of population management on competitive communities, studying the response of both locally stable and unstable communities of varying size (between four and 10 species) to three different management strategies; harvesting of a target species, harvesting with non-targeted catch, and stocking of the target species. We also studied the consequences of selecting target species with different relative abundances, as well as the effects of varying environmental conditions. We show here how the effects of management in competitive communities extend far beyond the target population. A crucial role is played by the underlying stability properties of the community under management. In general, locally unstable communities are more vulnerable to perturbation through management. Furthermore, the community response is shown to be sensitive to the relative density of the target species. Of considerable interest is the result that even a small (2.5%) increase in the population size of the target species through stocking may lead to extinction of other community members. These results emphasize the importance of considering and understanding multi-species interactions in population management.

Animals↗
PubMed1999

Regulating managed care: interest group competition for control and behavioral health care.

In this essay I identify how historic patterns of competition among health care interest groups have simultaneously retained their past contours and also changed significantly as a result of the jolt created by the rise of managed care. I explain why it is that I and other executives of for-profit managed behavioral health care organizations, traditionally advocates of market-based approaches to accountability, have begun to support some versions of regulation by the national government in order to restore consumer confidence in the credibility of managed health plans. Key concepts that are addressed include notions of public accountability, control of the purse strings, consumer protections, and provider privileges.

Behavioral Medicine↗
PubMed1995

The time is now.

Explore the source record for details and available documents.

Health Care Reform↗
PubMed1996

Cost analysis and the practicing radiologist/manager: an introduction to managerial accounting.

Cost analysis is inherently one of the most tedious tasks falling on the shoulders of any manager. In today's world, whether in a service business such as radiology or medicine or in a product line such as car manufacturing, accurate cost analysis is critical to all aspects of management: marketing, competitive strategy, quality control, human resource management, accounting (financial), and operations management, to name but a few. This is a topic that we will explore with the intention of giving the radiologist/manager the understanding and the basic skills to use cost analysis efficiently, making sure that major financial decisions are being made with adequate cost information, and showing that cost accounting is really managerial accounting in that it pays little attention to the bottom line of financial statements but places much more emphasis on equipping managers with the information to determine budgets, prices, salaries, and incentives and influences capital budgeting decisions through an understanding of product profitability rather than firm profitability.

Accounting↗