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PubMedDate not supplied

The Internet and managed care: a new wave of innovation.

Managed care firms have been under siege in the political system and the marketplace for the past few years. The rise of the Internet has brought into being powerful new electronic tools for automating administrative and financial processes in health insurance. These tools may enable new firms or employers to create custom-designed networks connecting their workers and providers, bypassing health plans altogether. Alternatively, health plans may use these tools to create a new consumer-focused business model. While some disintermediation of managed care plans may occur, the barriers to adoption of Internet tools by established plans are quite low. Network computing may provide important leverage for health plans not only to retain their franchises but also to improve their profitability and customer service.

Case Management↗
PubMedDate not supplied

Predicting response to regulatory change in the small group health insurance market: the case of association health plans and HealthMarts.

Lack of health insurance continues to be a concern for many people, even among those who are employed, and employees of small firms are much less likely to be insured than employees of larger firms. For several years, the U.S. Congress has considered legislation that would establish two new vehicles for offering health insurance coverage to small employers: association health plans (AHPs) and HealthMarts. In this paper, we present a model for estimating the impact the new entities would have on coverage and premiums in the small group health insurance market. The model produces a range of estimates based on assumptions, among others, about demand for insurance among small firms and their willingness to switch to less expensive, less generous benefit plans. We estimate that approximately 4.6 million people would obtain coverage through AHPs and HealthMarts, but fewer than half a million of them would be newly insured (based on 1999 population figures). Premiums would increase slightly for firms that continued to purchase coverage in the traditional market.

Community Participation↗
PubMed2004

Assessing risk-adjustment approaches under non-random selection.

Various approaches have been proposed to adjust for differences in enrollee risk in health plans. Because risk-selection strategies may have different effects on enrollment, we simulated three types of selection--dumping, skimming, and stinting. Concurrent diagnosis-based risk adjustment, and a hybrid using concurrent adjustment for about 8% of the cases and prospective adjustment for the rest, perform markedly better than prospective or demographic adjustments, both in terms of R2 and the extent to which plans experience unwarranted gains or losses. The simulation approach offers a valuable tool for analysts in assessing various risk-adjustment strategies under different selection situations.

Female↗
PubMed1991

Unrisky business.

Both the health insurance industry and its critics agree that reforms are needed to guarantee medical coverage for small businesses and their employees. The question is, how sweeping will the changes be?

Commerce↗
PubMed1990

State initiatives for the medically uninsured.

Recently, Medicaid has changed in terms of both perception and reality. After a period of decline in entitlement, that trend has been reversed through both Federal mandates and an increasing role for Medicaid in dealing with the uninsured. As States and the Federal Government seek structural solutions, further eligibility expansions may be necessary, such as public subsidies of private insurance of using Medicaid as a reinsurance mechanism. Currently, there is considerable State activity in identifying such solutions. These activities have given us some ideas about what is necessary to expand coverage to more of the population. Continued demonstrations and better definitions of the respective roles of the private and public sectors are needed.

Insurance Pools↗
PubMedDate not supplied

Are open-ended or point-of-service plans right for you?

Open-ended and point-of-service plans are relatively new methods of financing and delivering health care, writes Joseph Mack, M.P.A. He describes both plans in detail, along with the operational aspects of a medical group's involvement in such arrangements.

Group Practice↗
PubMed1991

What health care cost crisis?

Managed care has inherent limitations that, perhaps out of desperation for some degree of control of health care costs, we tend to disregard. A better understanding of the "crisis" and a host of new strategies become apparent when we separately consider the health care elements and cost elements of the crisis. Managed care is essentially palliative in that it eases symptoms without curing conditions. While this is not a call for the abandonment of managed care, it is a warning that our efforts will prove futile if we do not also address other fundamental elements of impaired health.

Aged↗