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At least 847 records · Page 47Linked to original sources
PubMed1996

Provider-sponsored networks. Physicians organize for direct contracting.

The Provider Service Network (PSN) concept is part of a wider movement by physicians to restructure for managed care to improve bargaining leverage for America's more than 600,000 active medical practitioners. Direct contracting has a simple appeal--no intermediaries. Imagine managed care contracts without the costs or hassles of an HMO or third-party intermediary. The PSN is a new form of managed care organization, but without the middleman. Savvy, self-insured employers, business coalitions, and government health programs are the potential "buyers." Doctors and hospitals are the "sellers," organizing provider networks on a regional and statewide basis. Up for grabs are over 225 million consumers whose health benefits are currently managed by insurance plans, HMOs, and third parties. This new marketplace of direct contracting may sound to doctors like the Garden of Eden, but there is plenty of opposition. PSNs will not become a national trend without a fight.

Case Management↗
PubMed1996

Health care integration: the role of information technologies.

Information technologies are rapidly becoming the major process drivers of health care system integration. These integrated information systems will emanate from MCOs and pervade the entire health care system at each level of service delivery. Suggestions for facilitating the integration process and the role of pharmaceutical industry, wholesalers, service providers, and end users are discussed herein.

Computer Security↗
PubMed1997

The power and potential of capitation.

Capitation creates a financial incentive to deliver care in the most appropriate setting. All major stakeholders in the health care industry (plan members, employers, practitioners, delivery systems, community organizations, and the government) share a common interest in managing risk sooner and better. Capitation can be a catalyst that encourages and reinforces this commonalty of purpose.

Attitude of Health Personnel↗
PubMed1997

Improving public/private partnership in managed behavioral healthcare.

This paper is the second version of a working document developed to explore opportunities and difficulties in the national shift to managed care in the public sector. Leaders in the public and private sectors continue their collaboration in contributing new models of integration that preserve the best of the public system but challenge the field to combine social mission with good business practice. The first version was developed by the American Managed Behavioral Healthcare Association and the National Association of State Mental Health Program Directors. This document, developed by AMBHA, NASMHPD, the National Association of County Behavioral Health Directors, and the National Council of Community Mental Health Centers, expands on the first white paper, published here in October 1995, and is based on developing issues and concerns in public sector managed behavioral healthcare. This paper is not intended to represent prescriptive standards but rather to articulate "best practice" in an area that continually changes as public payors privatize significantly larger portions of public mental health. In April 1996, Behavioral Healthcare Tomorrow published a response from the consumer advocacy perspective, and the ideas presented in this paper remain open to input and discussion.

Delivery of Health Care, Integrated↗
PubMed1996

Consumer information development and use.

The availability of informational materials to aid consumer health care purchasing decisions is increasing. Organizations developing and disseminating materials include public- and private-sector employers, providers, purchasing cooperatives, State agencies, counseling programs, and accreditation bodies. Based on case study interviews with 24 organizations, we learned that 10 included consumer satisfaction ratings and performance measures based on medical records. An additional four organizations developed materials with consumer satisfaction ratings exclusively. Printed materials were the most common medium used to convey information to consumers. However, other mechanisms for conveying the information were also employed. On the whole, the materials have not been rigorously evaluated. Evaluations are needed to determine if consumers find the information useful and how different individuals prefer to receive the information.

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