A publicly funded health care system embraces Medicaid managed care. To some safety net providers, providing quality care, serving the indigent, and providing medical training seem to conflict with managed care. See how the University Health System in San Antonio, TX, created new programs for its Medicaid and uninsured patients to meet its mission, compete with commercial Medicaid plans, and still survive.
Data File: For Medicare HMOs, it's all about money. Benchmarks and trends data from InterStudy show how managed care penetration, capitation rates, and medical loss ratios can give providers clues on plan viability and performance.
Boost your clout in negotiations with Medicare plans. Find out what Desert Physicians Association in Mesa, AZ, has learned in its dispute over reimbursement rates with CIGNA, and get some advice from a Medicare managed care consultant on how to negotiate contracts with Medicare plans.
Managing Medicaid lives without HMOs. Providers in Pitt County, NC, have developed their own kind of managed care plan that brings together traditional Medicaid providers with private physicians seeking to improve care quality and patient access. Providers in the plan hope it can keep commercial HMOs out of the local Medicaid business.
Collaboration in Medicaid solves providers' data reporting troubles. If you're looking for effective ways to give plans the information they want on pregnant Medicaid members and you want good programs for your high-risk patients, see how plans and providers in Philadelphia collaborated to improve birth outcomes.
Data File: Seniors most likely to join Medicare+Choice plans are those with no other source of medical insurance who want the most benefits they can get at the lowest out-of-pocket cost. A study by the Employee Benefit Research Institute finds the numbers of seniors in this category are increasing, especially among the poor, women, minorities, and those over age 85.
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