Managed care quarterly最新文献

Objectives: To determine overall satisfaction with primary care among people with cerebral palsy, multiple sclerosis, and spinal cord injury, and to identify potential differences in primary care satisfaction between managed care (MC) and fee-for-service (FFS) enrollees with these physical disabilities.

Participants: The sample consisted of 195 people with cerebral palsy (CP), multiple sclerosis (MS), and spinal cord injury (SCI), between the ages of 18 and 65 who had received primary care services in the six months prior to the survey.

Measurements: Satisfaction with various aspects of primary care were assessed using a 10-item self-report measure. Respondents were compared with regard to service satisfaction based on disability and insurance type (MC vs. FFS). Satisfaction items were summed up to produce an unweighted index of overall satisfaction. In the analysis we used non-parametric statistics, such as Kruskal-Wallis One Way ANOVA and Mann-Whitney Rank tests. Post hoc alpha corrections were performed using the Holms Stepdown Procedure.

Conclusions: The lack of disability-specific knowledge among primary care providers is consistent with findings of other studies. People with physical disabilities in managed care plans are less satisfied with how their providers communicate with them, relative to those in FFS plans. Poor patient-provider communication may place individuals with certain physical disabilities at risk for not receiving appropriate care.

The final HIPAA privacy modifications have substantially lightened the administrative, compliance, and liability loads borne by health plan and provider covered entities. Unlike under the original Clinton rules, for example, covered entities are no longer required to obtain patient consents, to monitor and mitigate the information practices of their business associates, or to treat patients as third-party beneficiaries of their business associate contracts. But the final modifications have done almost nothing to lessen the huge burdens and expense that will soon be imposed on those managed care entities that are merely business associates, a category that Congress never authorized HHS to regulate.

Quality within managed care plans continues to be a contentious issue. This article reports on a case study undertaken to identify the importance of health plan quality attributes to three key stakeholder groups affiliated with a single plan: employers, physicians, and consumers. Findings from a representative survey of these three stakeholder groups indicate that they value different attributes, and suggest that plans must be responsive to these varying perceptions of quality.

Although health insurance has traditionally been a cost center for employers, and they are ever striving to reduce such costs, MCOs have the opportunity to become a means for employers to save costs rather then suffer more. By focusing on the total health-related costs affecting businesses' bottom lines, MCOs can become "account managers, " where the "account" reflects all the costs that they can positively affect through their own initiatives, and thereby become true solutions rather than costs. This method will enable them to differentiate themselves from competitors and generate "solution pricing"-based new revenue focusing on outcomes versus coverage. This article covers the rationale for and basics of such a strategy.

An "evergreen contract" is one that automatically renews itself from year to year, unless one of the contracting parties acts at specified intervals (which may be annually or as long as several years) to give notice in the manner required to terminate the otherwise perpetual agreement. Such contracts are in contrast to fixed-term agreements, where both parties must affirmatively agree to extend the term beyond the initial specified term. Such "evergreen contracts" are legally valid, but for compelling reasons health plans and providers may want to consider terminating their evergreen provider contracts now in favor of a contract with a fixed term.