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At least 631 records · Page 35Linked to original sources
PubMed1997

Managing disabilities in an integrated health environment: the experience of Aetna.

Disability-related outlays are increasing at a rate well above the medical inflation rate. This article discusses the experience of one company in its attempt to manage these skyrocketing costs, by developing a new program that integrates health and related benefits by combining the medical and human resources interventions into a unified program. The authors discuss the initiation, development and progress of the program, concluding with measured results revealing reduced lost work time, improved employee health and productivity, and reduced disability costs.

Cost Control↗
PubMed1998

Claims on the Internet. A progress report on EDI developments.

While there's been a lot of talk about claims clearinghouses using the Internet as a conduit for receiving claims and related transactions from providers and employers, a major shift from conventional EDI has yet to materialize because of concerns about a number of issues, including security. In the meantime, some health care organizations are making plans to use the Internet and bypass clearinghouses.

California↗
PubMed1998

Florida Community Health Purchasing Alliances.

Until recently, many small businesses in Florida were unable to provide any type of health coverage to their employees because of high insurance rates. With the development of the Community Health Purchasing Alliance, the rates have decreased, enabling employers to offer health insurance to their workers. Often, employees can choose from a variety of health plans in terms of coverage and price.

Florida↗
PubMedDate not supplied

New opportunities for provider/insurers. Catholic healthcare organizations are well positioned for direct contracting.

Congress and a number of state governments have recently taken steps to encourage the formation of provider/insurer networks and other forms of "direct contracting" by providers with consumers. No group is better positioned than Catholic hospitals and medical centers, with their common heritage, not-for-profit status, and history of community service, to take advantage of direct contracting opportunities. Provider/insurer configurations fall into three categories: self-policing networks that assume full-risk contracts from payers; joint ventures between provider networks and existing insurance companies or HMOs; and provider networks that establish their own insurance capability. Anticipated changes in many states' insurance application processes will make it easier for providers to choose the latter option. The keys to a successful provider/insurer plan are differentiation from other insurance products in the market and a strong, consumer-friendly image. The involvement of physicians is vital, and the majority of physicians on any one hospital's staff should be members of the provider/insurer network. Currently, the Medicare population, rather than the commercial sector, is a good choice for a beginning provider/insurer network to cover. While such networks may be driven by either physicians or hospitals, a joint initiative by physicians and hospitals is preferable. Successful implementation of highly evolved medical management systems and related operational support is also key.

Catholicism↗
PubMed1998

Health insurance reform: national standard employer identifier--HCFA. Proposed rule.

This rule proposes a standard for a national employer identifier and requirements concerning its use by health plans, health care clearinghouses, and health care providers. The health plans, health care clearinghouses, and health care providers would use the identifier, among other uses, in connection with certain electronic transactions. The use of this identifier would improve the Medicare and Medicaid programs, and other Federal health programs and private health programs, and the effectiveness and efficiency of the health care industry in general, by simplifying the administration of the system and enabling the efficient electronic transmission of certain health information. It would implement some of the requirements of the Administrative Simplification subtitle of the Health Insurance Portability and Accountability Act of 1996.

Career Mobility↗