Search PubMed⌕ Search

SEARCH · Search PubMed

Results for “Health Planning Organizations”

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 19 recordsLinked to original sources
PubMed1982

New California strategy for medical assistance favors public health and organized plans.

In coming months, county governments in California will begin implementing regulations enacted by State Assembly that will change the settings for treatment of Medi-Cal (Medicaid) patients. The change will be dramatic, channeling medical assistance patients out of the offices of individual private practice physicians and into the offices of salaried doctors in public health settings or offices of doctors participating in organized health plans. Negotiated contracts with counties, institutions and non-institutional providers, patients, and fixed rates of reimbursement will become the parameters of medical service for providers of health care in the state's medical assistance program. For urban private solo practitioners in California whose practices rely heavily on publicly-supported patients, these changes hold a major threat, and for physicians throughout the nation it is a situation which should be watched carefully, because California is well known as a state which gives birth to changes that later appear in other states.

California↗
PubMedDate not supplied

Challenges faced by the HIV health services planning council in Oakland, California, 1991-1994.

This study reports the findings of a case study of the health services planning council established in the Oakland, California, eligible metropolitan area (the Oakland EMA) under Title I of the Ryan White Comprehensive AIDS Resources Emergency Act of 1990 (the CARE Act). We gathered primary data through observation of planning council meetings, examination of documentary evidence, and in-depth interviews with key participants. An important finding of this study was the inconsistency observed between the rational, linear planning model embedded in the CARE Act legislation and the politicized, emergent, and, at times, chaotic planning process actually observed in the Oakland EMA. The primary reasons for this inconsistency included confusion among council members about the planning council's responsibilities and authority, as well as its relationship with the local health department; limitations on administrative support at the local level; reluctance of program administrators at the federal level to provide advice concerning development of the council; allegations of conflict of interest among members of the council; pre-existing societal tensions and divisions; concerns about the representativeness of the council's membership; competition among providers of services for funding; conflicting demands for services by persons affected by HIV disease; disagreements between the council and providers of services over policies and procedures for administering the services contracts; and concerns about the council's involvement in the selection of specific agencies for funding, its lapses in compliance with rules of order, and its failure to accurately record minutes of all of its meetings. Despite the challenges faced by the Oakland planning council, it was able to meet its Title I obligations, which resulted in significant increases in the availability of medical and social services for persons affected by HIV disease. However, dealing with the confusion and conflicts described above consumed a considerable amount of the planning council's time and energy and eventually required a complete reorganization of the council to assure its stability and the legitimacy of the Title I program at the local level. Medical Subject Headings (MeSH): health planning councils; health planning organizations; health care coalitions; organization and administration; organizational innovation; models, organizational.

California↗
PubMed2004

Member success management for health plans.

Like all organizations, health plans have the choice of investing in efforts that will reduce their costs, or enhance their revenues. Clearly adding benefits to consumer members, particularly those who are so healthy that they currently use little health care, hence derive little value from membership, beyond the security of coverage, would promote retention of the most valuable members health plans have. While this may not pay off as immediately and directly to the bottom line as do cost-cutting measures, it may have far greater long-term value. Only by testing its potential and discovering the member retention and revenue-adding returns from such efforts, can plans learn how great this value can be.

Consumer Behavior↗
PubMed1997

Medicare program; establishment of an expedited review process for Medicare beneficiaries enrolled in health maintenance organizations, competitive medical plans, and health care prepayment plans--HCFA. Final rule with comment period.

This final rule with comment period establishes a new administrative review requirement for Medicare beneficiaries enrolled in health maintenance organizations (HMOs), competitive medical plans (CMPs), and health care prepayment plans (HCPPs). This rule implements section 1876(c)(5) of the Social Security Act, which specifies the appeal and grievance rights for Medicare enrollees in HMOs and CMPs. This rule requires that an HMO, CMP, or HCPP establish and maintain, as part of the health plan's appeals procedures, an expedited process for making organization determinations and reconsidered determinations when an adverse determination could seriously jeopardize the life or health of the enrollee or the enrollee's ability to regain maximum function. This rule also revises the definition of appealable determinations to clarify that it includes a decision to discontinue services.

Centers for Medicare and Medicaid Services, U.S.↗
PubMed2005

Brazilian National Standard for Electronic Form Interchange among Private Health Plan and Healthcare Providers.

Since 1988 the Federal Constitution of Brazil declared health care as a public right to be provided as a duty of the state(1). Thus the Unique Public System ("Sistema Unico de Saúde-SUS"), Ministry of Health, a comprehensive health care system with full coverage, was created since then. But the private sector has nevertheless also been operating since 1960s but without any government regulation at all. It serves approximately twenty-five per cent of the Brazilian population (estimated at 180 million of people).The National Supplementary Health Agency - NSHA ("Agência Nacional de Saúde Suplementar- ANS") was created in 2000 and is in charge of regulating and assisting the private health plan organizations. The public sector has been structuring its information systems for almost 15 years, defining standard schemes, such as the National Health Card Project, in order to institute a national unique identifier health care and to construct a national repository of health records.The lack of widely common information standards in the private sector, however, and the difficulties involved in the complex information interchange among private health plan organizations and health providers have caused NSHA to work out a proposal for a national standard for electronic form interchange proposal, based on XML technology, known as the supplementary health information interchange (TISS - "Troca de Informação em Saúde Suplementar"). The TISS project aims integrating healthcare information nationwide; therefore it was developed in accordance with the National Health Card Project, using the same unique identifiers and others standard sets proposed by the Ministry of Health, such as unique identifiers of providers.NSHA has presented the TISS project successfully to all stakeholders and is going to introduce legislation to enforce the standards. There are more than two thousands private health plan organizations in the whole country and more than ten thousands hospitals and clinics. Private health practioners, including dentists, will also have to adopt the standard. As a matter of fact, the TISS project not only focuses on the patient billing but also on epidemiological information. And the TISS project is not only for health provider claims, but also to all kinds of events such as consultation and exams.

Brazil↗
PubMed1983

Health maintenance organizations; Midwest Health Plan--Health Resources and Services Administration.

On January 21, 1983, the Office of Health Maintenance Organizations (OHMO) notified Midwest Health Plan (MHP), 3415 Bridgeland Drive, Bridgeton, Missouri 63044, a federally qualified health maintenance organization (HMO), that MHP had successfully reestablished compliance with its assurances to the Secretary that it would (1) maintain a fiscally sound operation, and (2) maintain satisfactory administrative and managerial arrangements. This determination took effect on January 1, 1983.

Health Maintenance Organizations↗
PubMed2006

Defining and implementing a national policy for science, technology, and innovation in health: lessons from the Brazilian experience.

The need for clearly-defined health research policies and priorities has been emphasized in the international scenario. In Brazil, this process began in 2003, when a group appointed by the National Health Council proposed 20 sub-agendas to account for the various health research specificities. The second step was to identify research priorities for each sub-agenda during national seminars involving 510 researchers and policymakers. The 2nd National Conference on Science, Technology, and Innovation in Health was held in July 2004. During the preparatory phase, 307 cities and 24 States organized local conferences, involving 15,000 participants. Some 360 health sector delegates were appointed during the local conferences, in addition to those from the education and science and technology sectors. During the Conference, the national policy was approved and 3 other sub-agendas were introduced and approved. The national policy and the priority agenda are currently guiding investments by the Ministry of Health for research and development, and to a certain extent those from the Ministry of Science and Technology as well. From 2003 to 2005, 24 calls for proposals were launched; as a result, 3,962 research projects were submitted and 1,300 financed.

Biomedical Research↗
PubMed1983

Grant application cycles; health systems agency grants and state health planning and development agency grants--HRSA.

This Notice is issued in accordance with Executive Order 12372, Intergovernmental Review of Federal Programs as implemented by HHS in 45 CFR Part 100. The scheduled application due dates and funding dates for health systems agencies (HSAs) and State Health Planning and Development Agencies (SHPDAs) are provided below to assist States and other entities within a State in determining the comment period as required under 45 CFR Part 100.

Health Planning Organizations↗