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Much of the future success of managed care organizations will depend on the quality of the direction provided by medical directors. The increasing complexity of the health care industry, manifested by intense competition for patients and reduced levels of reimbursement, will necessitate that HMOs, PPOs, IPAs, and utilization review firms begin to differentiate their services according to clinical protocols and outcome measures.
This study examined financial and operating data for approximately 1,000 U.S. hospitals categorized by Medicare as "large urban" to determine critical relationships between business strategy and financial performance. Cost control was found to be the most important factor influencing financial performance. Other factors of importance included market share, diversification, and financing policy.
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In today's high-pressure, speed-oriented environment, health-care managers face the challenge of helping their staff achieve a higher level of customer service without overwhelming them. Although raising the bar on customer service is crucial to stay competitive, if managers expect staff to institute many customer service improvements at once, staff often respond with confusion, frustration, and resistance. Then results are disappointing, and managers flounder in their efforts to inspire staff to stretch toward higher standards. By prioritizing customer service goals and selecting one goal at a time as the focus, you and your team can institute and sustain improvements successfully. Whether the goal is improving "meeting and greeting," response time, handling complaints more effectively, providing better instructions, or other customer service goals, the one-goal-at-a-time focus makes it possible for staff to understand the desired change, embrace it, learn it, practice it, and savor positive results. By following a simple 6-step process and applying this same process to one goal after another, staff become familiar with the process and it becomes easier to apply in pursuit of future goals. The result: a higher return on the investment of your efforts and your staff's precious time and attention.
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PURPOSE: Although the body-mass management strategies of athletes in high-participation weight-category sports such as wrestling have been thoroughly investigated, little is known about such practices among lightweight rowers. This study examined the body-mass management practices of lightweight rowers before competition and compared these with current guidelines of the International Federation of Rowing Association (FISA). Quantification of nutrient intake in the 1-2 h between weigh-in and racing was also sought. METHODS: Lightweight rowers (N = 100) competing in a national regatta completed a questionnaire that assessed body-mass management practices during the 4 wk before and throughout a regatta plus recovery strategies after weigh-in. Biochemical data were collected immediately after weigh-in to validate questionnaire responses. Responses were categorized according to gender and age category (Senior B or younger than 23 yr old, i.e., U23, Senior A or OPEN, i.e., open age limit) for competition. RESULTS: Most athletes (male U23 76.5%, OPEN 92.3%; female U23 84.0%, OPEN 94.1%) decreased their body mass in the weeks before the regatta at rates compliant with FISA guidelines. Gradual dieting, fluid restriction, and increased training load were the most popular methods of body-mass management. Although the importance of recovery after weigh-in was recognized by athletes, nutrient intake and especially sodium (male U23 5.3 +/- 4.9, OPEN 7.7 +/- 5.9; female U23 5.7 +/- 6.8, OPEN 10.2 +/- 5.4 mg x kg(-1)) and fluid intake (male U23 12.1 +/- 7.1, OPEN 13.5 +/- 8.1; female U23 9.4 +/- 7.4, OPEN 14.8 +/- 6.9 mL x kg(-1)) were below current sports nutrition recommendations. CONCLUSION: Few rowers were natural lightweights; the majority reduced their body mass in the weeks before a regatta. Nutritional recovery strategies implemented by lightweight rowers after weigh-in were not consistent with current guidelines.
Group practices that employ physicians on a contractual basis face a number of risks. Among these risks are the possibility of employee-physicians engaging in competitive activities; the practice's potential liability for outside services its physicians may perform; and the possibility of breaches of patient and practice confidentiality. By drafting employment agreements that include provisions that minimize such risks, practices can strengthen their market position and protect themselves from potential losses.
The premise of this article is that there is both a process that can be tailored to specific situations and outcomes that can be formatted to guide any managed care business. However, if neither are put together under the guise of strategic management, the managed care business (as we know it) will become both "futile" and "fatal" for many. It is understood that the managed care perspective for the provider can be much different than for the buyer/payor. In fact, the process for planning these outcomes (strategic management) remains the same. What changes is the perspective! This article presents a framework for that perspective.
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Administrators of the plan acknowledge the pitfalls of financial incentives for quality, and still say such incentives have helped improve quality of care for members.
In today's hyperturbulent and competitive health care environment, health care organizations must improve operating efficiency, reduce duplication, and compete effectively in the health care market to survive. The comprehensive organizational plan is a 5-stage development tool for health care organizations that is intended to protect and serve the health care organization in its survival efforts. Through its 5 planning stages-competitive, facilities, financial, human resources, and marketing-the comprehensive organizational plan assists the organization in optimizing the goals of cost containment, quality preservation, and universal access.
Cognitive behavioral stress management (CBSM) has previously been found to reduce fatigue, depression, and cortisol response to heavy exercise training among competitive collegiate athletes and to speed physical and psychological recovery from surgery. Our study assessed the efficacy of a CBSM program to reduce the frequency of injury and illness among collegiate athletes in a randomized, single-blind, controlled clinical trial. Following assessment of baseline medical history, mood state, stress, cortisol, sleep, alcohol use, and exercise training, collegiate rowers were stratified by gender and competitive level and randomly assigned to either a control group or a CBSM group. Exercise training information and psychosocial assessments were repeated immediately following the intervention period, and health care providers who were blinded to participant assignment recorded the frequency of medical visits and the number of days injured or ill until the end of the season. Athletes randomly assigned to a CBSM group experienced significant reductions in the number of illness and injury days as compared to control group athletes. CBSM participants also had half the number of health service visits as did controls. The data suggest that a time-limited CBSM intervention designed specifically for an athlete population may be an effective prophylactic treatment to reduce the incidence of injury and illness among competitive collegiate athletes.
Single health care purchasers and purchasing coalitions are using price, quality and access indicators to help evaluate health plans and foster competition among them. Purchasers also are providing employees with financial reasons to be cost conscious in choosing a health plan and utilizing health services. And they are dispensing information to combat employees' negative perception of managed care.
One of the most utilitarian developments in the field of quality assurance in health care has been the introduction of industrial concepts of quality management. These concepts, coupled with buyer demand for accountability, are bringing new perspectives to health care quality assurance. These perspectives provide a new view of quality assurance as a major responsibility and strategic opportunity for management; a competitive and marketable commodity; and a method of improving safety, effectiveness, and satisfaction with medical care.
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Physician-organization integration (POI) has emerged as a key issue for hospitals and health systems seeking to improve the quality and cost-effectiveness of care. Although competition and managed care are often cited as primary market drivers of the adoption of POI strategies, prior research has shown only weak associations between these market attributes and POI. This article argues that the role of key organizational decision makers has not been adequately accounted for in explaining strategic change. The study examines the role of hospital CEO perceptions of competition in predicting the adoption of five different approaches to POI. CEO perceptions of general market competition are explained by a combination of market and organizational attributes. Furthermore, when controlling for objective characteristics of the environment and organization, CEO perceptions of competition have consistent, statistically significant associations with four of five measures of POI examined.
After twenty-five years of a consistent health insurance underwriting cycle, the pattern of insurer profitability changed greatly in the 1990s, raising speculation about the future. We conclude from interviews with industry experts that health plan competition and limits on plans' ability to predict costs will continue to drive a cycle, albeit one even more muted than it was in the 1990s because of changes in industry structure and forecasting improvements. Plans will price closer to cost trends and forego the more heated price competition that drove major losses in the past, reducing premium volatility but possibly leading to higher average premiums.