Managed care quarterly最新文献

Healthcare providers are being pushed to provide better service, yet maintain costs; and one of those costs is claims processing. There are many hurdles providers must jump over in the transition from capitation to "fee for service" billing structures, as well as potential issues surrounding new claim payment timeliness legislation. This article presents some possible solutions for making the claims process more efficient.

Information therapy is the prescription of specific information to a specific person at a specific time to help with a health decision. Correctly prescribed, information becomes medicine--powerful medicine. Information therapy can be as important to a patient's health as any drug, medical test, or surgery. Physicians value the information and advice they give to patients as their most important service, yet the way they perform that service hasn't changed for a hundred years. Doctors still rely chiefly on their clinical experience, their memory, and the spoken word to convey essential information to patients. When patients misunderstand, ignore, or forget the information, this vital service is wasted.

Systems-based practice is an important aspect of medical education. This study evaluates the effectiveness of an eight-hour intervention on medical students' knowledge of the principles of managed care. A pre-test on basic managed care principles was administered to freshman medical students at Mercer University. After an eight- hour managed care curriculum was presented to these students, a post-test was administered. The pre-test and post-test scores on the material increased a mean score of 9.7 points (p < 0.001). Our conclusion is that providing as little as eight-hours of instruction on managed care topics can significantly improve first-year medical students' knowledge and understanding of systems-based practice.

Strategies for redesign are necessary in successful managed care organizations as the member population grows and changes. This article presents a redesign project initiated by a managed care plan located in the Southwest region of the United States, where the rural frontier blends with metropolitan cities in a culturally diverse population. The focus of this project is the redesign of the Health Services department in which case management resides.

This is the first in a series of articles that address the complex issues associated with specialty pharmaceuticals in the development of a successful specialty pharmaceutical program, a critical component of managing this high-cost and highly fragmented sector. This article focuses on how to define specialty pharmaceuticals. Other articles in this series will explore such topics as the mechanics of developing and managing a specialty pharmaceutical program, how and when to establish clinical protocols and authorizations, the importance of data management, and the benefits from automated processes.

On April 25, 2002, the Internal Revenue Service finalized the proposed Corporate Sponsorship regulations. The changes made in the final regulations pertain to the proposed $79 ceiling on disregarded benefits, the 2 percent threshold for disregarded benefits, the scope of disregarded benefits, Web site hyperlinks, the inclusion of certain electronic publications in the definition of periodicals, the valuation date for substantial return benefits, and the scope of use or acknowledgement. The proposed regulations were discussed in the Winter 2002 issue of Managed Care Quarterly in an article titled the same as this one. This article is based on the final IRS regulations and therefore supersedes the original article published in the Winter 2002 issue.