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Biomedical subjects

C H Coulter

Publications and source records attributed to C H Coulter.

12 recordsLinked to original sources
PubMed2000

Health benefits: employer liability and the need for change.

The cost of health care benefits has been rising much faster than overall inflation recently, and employees are increasingly dissatisfied with the programs being offered. This has left many human resources professionals searching for a better way. Against this background, attempts to increase employer liability pose serious threats. While some employers might consider abandoning health benefits to avoid this expanded liability, other alternatives may be more appealing and may be equally effective at limiting liability.

Health Benefit Plans, Employee↗
PubMed1999

Direct provider contracting: one employer's experience.

Employers and unions typically offer an array of health care options to their plan participants including many managed care options. However, until recently, few have considered contracting directly with an integrated delivery system (IDS), therefore circumventing health plans altogether. This article offers a case study of one employer's experience with direct IDS contracting, including employee contribution strategy, benefits design and evaluation of the delivery system.

Contract Services↗
PubMed1998

Assessing HMO centers of excellence programs: one employer's experience.

HMOs have sought to enhance the provision of organ and tissue transplantation services for their members through centers of excellence (COE) programs. Such programs initially assess and subsequently monitor the medical centers offered as part of such programs on the basis of procedure volumes and outcomes, as well as the experience of the transplantation surgeons. Purchasers rely on the presence of COE programs to assure their beneficiaries of access to appropriate care in the event that a need for transplantation arises, but little comparative literature exists on these HMO programs. One purchaser assessed the COE programs offered by 89 HMOs serving its beneficiaries, based on the criteria developed on its behalf by the medical directors of six different health systems and reviewed by HMO and academic medical center personnel. 57 (75 percent) met these criteria, and the implications for HMOs, medical centers, beneficiaries, and other purchasers are explored.

Benchmarking↗
PubMed1997

Partnerships for the delivery of cancer care.

Academic oncologists representing prominent academic medical centers and medical directors representing a variety of HMOs have been meeting to confront the issues separating these two groups. Collaborations for Fostering Quality Cancer Care: Examining Partnerships Between Managed Care Organizations and Academic Medical Centers and Partnerships for the Delivery of Cancer Care were conferences jointly sponsored by the Lombardi Cancer Center of Georgetown University and the Xerox Corporation which looked at the obstacles to successful joint efforts and at successful existing partnerships between academic centers and HMOs. During these sessions it became apparent that there is real concern about the survival of the academic cancer centers and for their research, education and patient care missions. But successful partnerships between academic medical centers and HMOs do exist. These offer a model of working relationships that can incorporate both the traditional missions of the academic medical centers and the need for cost-effectiveness which HMOs champion.

Academic Medical Centers↗
PubMed1995

If patients are now "customers," what does that make physicians?

As patients become "members" and "customers," as physicians become "practitioners" and "providers," the practice of medicine becomes more complex and more demanding. The changes that have affected the daily lives of physicians across America will continue and will likely become even more dramatic in the future. There is much to mourn in the passing of the medical practice of the recent past, but there is every reason to celebrate the ongoing triumphs of medicine and its successes in improving the human condition. The job of being a physician is not becoming any less important. The job has just gotten tougher. Successful physicians will cope with the multitude of changes in which the health care field is engaged and make themselves effective agents of change within their organizations.

Health Maintenance Organizations↗
PubMed1995

When push comes to shove: implementing VBAC practice guidelines.

The dramatic increase in U.S. cesarean sections over the past two decades has been significantly driven by repeat C-sections. In response to this trend, clinical guidelines recommending vaginal birth after cesarean-section (VBAC) have been promulgated by national organizations. Adherence to these guidelines would reduce the number of repeat C-sections, lower the overall C-section rate, and improve both the quality and the cost of health care. While these guidelines have received professional endorsement, their implementation has been clouded by issues of patient acceptance and provider payment. To examine implementation of these guidelines by health care organizations, the authors surveyed 156 members of the American College of Physician Executives to determine their policies, practices, and attitudes toward VBAC guidelines. Those surveyed generally were medical directors in HMOs, hospitals, and other practice settings. The findings indicate that the health care organizations represented by these physician executives have not consistently implemented VBAC guideline and that they are reluctant to hold physicians, their patients, or hospitals accountable for the financial, utilization, and quality impact of the elective decision ot to pursue appropriate VBACs. We conclude that, even when widely accepted, clinical practice guidelines may be ineffective in reducing the costs or improving the quality of medical care.

Attitude of Health Personnel↗
PubMed1993

Selecting affiliates for a national HMO network: developing and implementing performance standards.

The evaluation process was developed for a specific, unique purpose. The subsequent success of the network and the performance of its HMOs in satisfying member and employer requirements lend support to the assertion that this was an effective approach. That success has also allowed the HMOs to benefit from national network affiliation through increased membership and revenue. The network offers its affiliates the prospect of making a transition from local HMOs to a national health care delivery system over the coming years.

Contract Services↗
PubMedDate not supplied

Will retiree health benefits survive FAS 106?

Recent months have seen dramatic public announcements about retiree health care coverage. General Motors recorded a $24 billion quarterly loss this year, due almost entirely to a one-time charge for future retiree health care costs. Other major employers have also reported sudden staggering losses, along with plans to decrease or stop retiree health coverage entirely. Some of these companies have been taken to court. The headlines also identify a culprit--an obscure accounting requirement, Financial Accounting Standard 106. To understand how an accounting rule can have such a profound effect on both the health care of our seniors and the financial strength of American industry, it is necessary to understand how employers pay for their retirees' care, how new accounting rules governing these costs can threaten a company's survival, and how employers are changing their employees' health coverage to meet these threats.

Accounting↗
PubMedDate not supplied

Purchasers and the impact of managed care on physicians.

In much the same way that demands by managed care organizations are shaping the way physicians practice, health care purchasers impact how managed care organizations operate. Corporations purchase managed health care through their employee benefits programs, and understanding the language, objectives, and limitations of these purchasers is essential to grasping the forces influencing managed care organizations and the modern practice of medicine. The emergence of value-based purchasing as a strategic corporate approach to health benefits programs will dictate the forces on physicians, hospitals, and managed care organizations for years to come. These forces have already led to price reductions, health plan accreditation, employee-directed report cards, outcomes management, and organized systems of care, and they will determine the broad outlines of the emerging U.S. health care system.

Contract Services↗
PubMedDate not supplied

The consumer choice model: a humane reconstruction of the U.S. health care system.

"Consumer choice," "defined contribution health programs," "voucher systems," and "health marts" are variations on a theme: employees buying their own health care. This new approach to health care purchasing, which is designed to minimize the role of employers, is being proposed by an array of economists and by both Republican and Democratic legislators as the best way to address the nation's health care ills. Although enabling national legislation is unlikely to pass soon, the debate will nevertheless change the face of health care in America. The prospect is reminiscent of the debate over "Clinton Care" in 1993--although legislation was never passed, managed care rapidly came to dominate the U.S. health care system. As this reform takes hold, beneficiaries will make their own health plan selections but will have more responsibility and may bear more cost. Providers will have to adapt to new, customer-driven requirements for performance, accountability, and communications but will also find opportunities in a marketplace that they will have a major role in shaping. Physicians, health plans, and insurers should understand how these proposals will transform their role in health care.

Choice Behavior↗