Search PubMed⌕ Search

SEARCH · Search PubMed

Results for “Managed Competition”

Search indexed PubMed citations on genomics, clinical trials, systematic reviews and public health. Explore titles, authors and supplied subject terms, then open the PubMed record.

Quote a phrase for an exact phrase match. Source license links do not imply unrestricted reuse.

At least 883 records · Page 49Linked to original sources
PubMed1998

Combating silent PPOs.

A silent PPO is a contracting entity that negotiates discounts with providers but sells access to the discounts to other, nonrelated parties after services are provided to individuals covered by the nonrelated parties' insurance policies. Healthcare financial managers should be alert to the presence of silent PPOs when entering into contract negotiations. To combat silent PPOs, a two-pronged approach--prevention and detection--is advisable. Factors to consider include appropriate contract language stating that all clients with access to the discounts have a contract with the PPO, presence of the PPO's logo on a patient's insurance card, and the PPO's willingness to limit the number of providers in its network. Warning signs that indicate the presence of a silent PPO include a high volume of retroactive reclassifications, single employers taking discounts from multiple PPO networks, or payments for services provided to single individuals coming from multiple PPO networks.

Contract Services↗
PubMedDate not supplied

Giving yourself an edge.

Explore the source record for details and available documents.

Administrative Personnel↗
PubMed1998

When you look in your crystal ball, do you see a PSO in your future?

This is the first part of a two-part series on provider-sponsored organizations (PSOs) and what providers should consider before establishing one. The PSO regulations, which were not available at press time, will be discussed in a future issue. Other future topics will include an explanation of PSO solvency standards, tips on marketing a Medicare product, and information about why you need a compliance plan before starting a PSO.

Budgets↗
PubMed1998

Part II: What do employers mean by "value"?

With health care costs clearly on the rise again, and First Generation Managed Care having matured itself into market gridlock, it is inevitable that there will be a second "employer" revolt. As long as private purchasers do not see organizations fully focused on "value" as they see it, they will not be content with rising costs as "unavoidable". And whereas I do not believe we will see the double digit increases of the 1970's and 80's, consistent annual increases of greater than 5% (or 2-3 times the general inflation rate) will become a major problem, particularly when the current economic expansion ends, and top-line growth in revenues and profits outside the health care sector are once again under pressure. The timing of this second employer revolution is anyone's guess, but it is likely to occur with lightning speed on the heels of a major and sustained correction in the global market. Employers will be looking to move volume to organizations that can offer the best value. Integrated health systems have the potential to become these organizations but, they have significant hurdles to overcome. However, from the private sector point of view, if doctors are willing to listen, learn a new language and become committed to accountability and measurement, employers innately believe that those closest to the "customer" (i.e. patients) are best able to manage. Whether, provider systems can rise to this challenge is unclear. But the stakes, for physicians, purchasers and ultimately patients, have never been higher. And employers, as a group, are hopeful that these organizations can live up to their promise.

Consumer Behavior↗
PubMed1986

Information systems: the direction of things to come.

In the past, very little emphasis was placed on the development of high quality information systems support producing useful information. However, in an increasingly competitive environment, managers will need good information to make sound business decisions and to survive. Good information will be the result of an information system that is easy to use and can gather information from many different sources. Hence, in the future, information systems will move in the direction of decision support assistance, integrated patient care systems, stand-alone application systems, and increased access and integration, to help the manager in the decision-making process.

Computers↗
PubMedDate not supplied

Local healthcare executive groups: tapping networking opportunities.

Local healthcare executive groups (LHEGs) represents a tremendous local, regional, and national networking opportunity both for individual health care executives and the American College of Healthcare Executives (the College). The increasing competition for management positions, the ongoing need to attract talented individuals to the field of health administration, and the strategic positioning of the College make this a crucial time for LHEGs to take steps to ensure that viable, dynamic organizations exist at the grass roots level. This article presents a profile of LHEGs in the United States today and highlights important future collaborative directions for LHEGs, the College, and the field at large.

Career Choice↗