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Biomedical subjects

G Carneal

Publications and source records attributed to G Carneal.

7 recordsLinked to original sources
PubMed2001

Defining the parameters of case management in a managed care setting.

The authors explore how case management evolved from utilization review in order to address the lack of flexibility of basic utilization review. They examine case management's widely diverse state regulatory oversight as well as its lack of a clear definition. The authors then suggest three mechanisms that might be used to devise a universal definition of case management. For the purposes of this article, the authors use the term case management in connection with health benefits plans.

Accreditation↗
PubMed2000

The evolution of utilization management.

Utilization management has been one of the most useful managed care tools since the early days of this health delivery model. Recently, utilization management has come under siege, not directly as a result of public outcry, but from within the industry itself. One expert describes how utilization management must evolve to keep pace with the changing managed care environment.

Decision Support Systems, Clinical↗
PubMed1996

Any willing provider debate heats up in the courts.

No anti-managed care initiative has received more attention in the 1990s than any willing provider (AWP) proposals. Interestingly, state AWP enactments have recently slowed. However, litigation focused on the interpretation of existing laws is heating up in both state and federal courts around the country.

Employee Retirement Income Security Act↗
PubMedDate not supplied

Blurred boundaries: state regulation of PHOs.

Health plans that look alike to patients don't all have to meet the same standards for quality of care, benefits, and solvency. A recent GHAA 50-state survey looks at the regulation of one of the newer health plan models--the PHO.

Actuarial Analysis↗