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At least 559 records · Page 31Linked to original sources
PubMed2000

Assessment of the Massachusetts Behavioral Health Program Year 6.

After a difficult transition from the previous vendor to the Massachusetts Behavioral Health Partnership (MBHP), Year 6 was a year of stability and incremental changes for the Massachusetts Behavioral Health Program. This assessment of Year 6 is based on interviews with key players, data provided by the MBHP, a survey of providers, as well as on the fifth year of an ongoing review of the program. Results indicate that enrollment grew, and new services were developed in response to identified needs. Providers considered access, utilization, and quality of care to be the same or better than a year earlier. Coordination improved, but was not optimal. Clinical and overall decisions with MBHP were collaborative or negotiated and less hierarchical in manner than the previous year. Providers rated MBHP better than other managed care organizations on quality of care and utilization review decisions, access, flexibility, and administration.

Child↗
PubMed1993

The link between continuous quality improvement and case management.

During the past several years, the continuous quality improvement (CQI) process has gradually been adapted to the healthcare setting to improve quality without increasing costs. In traditional quality assurance models, quality is measured by the number of accidents or errors occurring. No provision is made for improving the conditions under which the errors occurred. However, continuous quality improvement focuses on the processes used to achieve a goal. These processes may be clinical, financial, or operational issues. Each step in the process is analyzed; then a plan for improvement is tested and refined. The concepts of quality improvement that have been applied in the industrial setting are now being applied in the healthcare arena. Case management and CQI are linked in philosophy and process. The steps of the CQI process can be applied to managed care plans from both a clinical and financial perspective.

Costs and Cost Analysis↗
PubMed1995

Managed care and the business of risk management.

The emergence of managed care creates the need for a new paradigm of risk management because of its emphasis on comprehensive services and prospective payment. Information systems, contracts and pricing, utilization management, and outcome research are key elements in devising the new paradigm.

Capitation Fee↗
PubMed1999

Managing managed care.

Managed care trends--such as acquisitions of local physician practices, mergers among payor and provider organizations and changes to the current role of managing care--means a difference in the way information systems must operate.

Accounts Payable and Receivable↗
PubMed1999

Managed care in the age of accountability.

We know that managed care offers opportunities to HIM professionals, but what role does information itself play? This article surveys the kinds of health information that managed care organizations need to make decisions. The author looks at processes related to care delivery and gives examples of the type of information each area requires.

Case Management↗
PubMedDate not supplied

New York State's Medicaid-only managed long-term care program.

This policy brief describes an innovative model of managed long-term care (MLTC) in New York State (NYS) that serves Medicaid eligible adults at a nursing home level of impairment, most of whom are also eligible for Medicare. The ten MLTC plans discussed here are capitated to provide all Medicaid funded long-term care (LTC) benefits. Plans are also responsible for coordinating primary and acute care services covered by Medicare. This MLTC model is currently offered by ten diverse organizations throughout the state and serves over 4,500 voluntary participants. It is the newest of the four MLTC models operating in NYS.

Adult↗
PubMed1999

Shifting the costs of indigent care back to county governments.

Despite a decade of steadily rising prosperity, Texans are losing health care benefits at an alarming rate. As many as 41 million people in this country, or 15% of the population, lack health care coverage of any kind. Most of these people are under age 65 and are gainfully employed, but their employers don't provide coverage and/or don't pay them enough to afford it themselves. Most have minimum wage jobs and are ineligible for Medicaid. These individuals plant the gardens, work in fine restaurants, clean expensive houses, and generally benefit the communities in which they reside. Texas law suggests that county governments and property owners should pick up the tab for the medically indigent. However, as the uninsured numbers grow, county governments are finding ways to extricate their taxpayers and the institutions they support from the obligatory role as payer of "last resort" for these people. While reimbursement from government programs, managed care, and commercial insurers is putting tremendous financial pressure on health care providers, the county systems simply are not assuming their financial, legal, or ethical responsibilities for those outside the protective cover of these programs. In my experience, health care for the medically indigent has become "charity care" at the profit and nonprofit hospitals in the state. The strain is palpable in the emergency rooms, where by law the medical crises of the poor must be treated. This de facto safety net is fraying, and our political leaders need to make the painful decision to raise sufficient tax revenues to remove the weight.

Eligibility Determination↗
PubMed1993

Hospital managed care performance standards.

If hospitals do not establish their own managed care direction and contracting performance standards, they will inevitably find themselves in a reactive position. This must be avoided as managed care is one of the few payor segments that hospitals still have the opportunity to influence.

Contract Services↗
PubMed1998

Patient rights meet managed care: understanding the underlying conflicts.

During the past several years, one of the favored areas for legislative (and editorial) debate in our Nation has been the proper level of legal protections that should be accorded to those individuals who have chosen to become members of managed care plans. As examined in the following article, this debate often rages with little notice being paid to the underlying conflicts between managed care and "patient's rights." Indeed, at times, the vociferousness of the debate obscures even those instances in which there is little fundamental conflict.

Conflict, Psychological↗
PubMedDate not supplied

AACVPR consensus statement. Outcomes evaluation in cardiac rehabilitation/secondary prevention programs: improving patient care and program effectiveness.

The reported outcomes statement is an update to the previous recommendations for outcomes evaluation in cardiac rehabilitation/secondary prevention programs. The purposes of outcomes evaluation are reviewed, and practical information with examples is provided to help programs implement an outcomes-directed approach within routine patient care and program management functions.

Consensus↗
PubMed2003

IS/IT the prescription to enable medical group practices attain their goals.

The US spends significantly more money as a percentage of GDP on health care than any other OECD country and more importantly, this amount is anticipated to increase exponentially. In this high cost environment, two important trends have occurred: (1) the movement to managed care, and (2) large investments in Information Systems/Information Technology (IS/IT). Managed care has emerged as an attempt to provide good quality yet cost effective health care treatment. Its implications are not well discussed in the literature while, its impact on different types of medical group practices is even less well understood. The repercussions of the large investments in IS/IT on the health care sector in general and on the medical group practice in particular, although clearly of importance, are also largely ignored by the literature. This study attempts to address this significant void in the literature. By analyzing three different types of group practices; an Independent Practice Association (IPA), a Faculty Practice and a Multi Specialty Group Practice in a managed care environment during their implementation of practice management/billing systems, we are able to draw some conclusions regarding the impacts of these two central trends on health care in general as well as on the medical group practice in particular.

Contract Services↗
PubMedDate not supplied

20/20 vision care.

Explore the source record for details and available documents.

Credentialing↗