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At least 469 records · Page 26Linked to original sources
PubMed1999

Online solution for tracking payer data.

Keeping on top of constantly changing managed care policy requirements can be labor intensive and prone to error. At the University of Missouri Health Sciences Center, over 20 percent of patients are under managed care arrangements for services. The center maintains over 50 contracts with insurers. The medical center thus faces the logistical nightmare of keeping information regarding insurer contact information, pre-certification and prior-authorization policies up-to-date and accessible to front-line clerical and nursing support staff. The medical center is trying to solve the problem by keeping real-time information stored on an easily accessible, searchable Web site.

Contract Services↗
PubMed1999

Risk pools: payers and providers take the plunge.

Providers considering managed care risk pool arrangements should understand thoroughly what services the pool covers, the time period covered, and how the pool is administered. Important issues related to pool administration include how credits and debits are applied; when the accounting occurs (interim, year-end, or contract termination); and provisions for reports, audit rights, and dispute resolution. Although a pool arrangement gives the health plan control over claims payment, the risk allocation made possible through a pool arrangement helps ensure that the economic incentives of the health plan and the provider are aligned.

Capitation Fee↗
PubMed2000

Growth hormone use in transitioning patients--clinician and payer concerns.

Determining which patients with childhood-onset growth hormone (GH) deficiency will require continuing GH therapy into and/or throughout adulthood raises clinical and economic issues, such as retesting, appropriate dosing, and the risks and benefits of uninterrupted GH treatment versus the discontinuation of therapy. In his review of the evaluation and management of patients transitioning from GH therapy in childhood to GH therapy in adulthood, Dr. Stephen LaFranchi focuses on the odds of having ongoing GH deficiency, the changes that occur when therapy is discontinued, appropriate follow up of patients who discontinue treatment, and issues regarding the reinitiation of therapy. Dr. Margaret H. MacGillivray addresses appropriate monitoring and follow up of patients in transition, as well as their classification by etiology and severity of GH deficiency. Dr. Pete Fullerton explores new issues regarding GH deficiency treatment from a managed care perspective.

Adolescent↗