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Explore indexed PubMed citations for clinical trials, systematic reviews and public health research. Read source abstracts and follow each citation to its original PubMed record.

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PubMed1998

Providers: hold yourself accountable before payers, others do it for you.

Financial performance data: Drilling down into comparative data can help health care providers quickly identify where costs are out of line. See samples of easy-to-read graphs you can adopt for your organization for everything from broad hospital measures to specific physician ordering practices.

Arizona↗
PubMed1999

Prescription costs become harder to swallow. Providers and payers get a big dose of reality with explosive spending and patient demand for new drugs.

Hospitals and managed-care organizations know that pharmacy costs are going to keep climbing. It's a question of how much and how quickly they can slow the growth of an expense that has become increasingly hard to swallow. Spending on prescription drugs is rising at 12% per year, more than double the 5% increase in national healthcare expenditures.

Cost Sharing↗
PubMed1999

Using hospital-based case management to reduce payer denials.

Peninsula Regional Medical Center in Salisbury, Maryland, sought to implement a case management program to reduce a rising number of denied claims for avoidable, nonacute-care inpatient days. Initial efforts focused on consolidating functions rather than monitoring and managing care, and denied claims continued to increase. A revised case management program based on assertive resource management rapidly and substantially reduced claim denials.

Case Management↗
PubMedDate not supplied

Protect your practice: payers for sale.

Mergers and acquisitions are common among managed care plans today, When an HMO puts itself on the market, it wants to make itself as attractive as possible to a potential buyer. The contracting strategies and operational changes it may pursue as a result offer both challenges and opportunities to physician practices. Whether contracting directly with managed care plans or participating in a contracting entity such as an IPA or PHO, you should understand how to best position your practice should an HMO in which you participate goes up for sale.

Contract Services↗