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At least 577 records · Page 32Linked to original sources
PubMed2006

Medicaid managed care model of primary care and health care management for individuals with developmental disabilities.

Lack of sufficient accessible community-based health care services for individuals with developmental disabilities has led to disparities in health outcomes and an overreliance on expensive models of care delivered in hospitals and other safety net or state-subsidized providers. A functioning community-based primary health care model, with an integrated care management component, functioning in the general health care practice marketplace, is described and shown to address recent Surgeon General recommendations as well as evaluative criteria for availability, affordability, acceptability, and appropriateness of care. The model functions in both fee-for-service and managed care environments, including Medicaid managed care for individuals with developmental disabilities. Experience shows this model to be both scalable and replicable, resulting in positive health outcomes and increased patient satisfaction.

Health Services Accessibility↗
PubMedDate not supplied

Growing an industry: how managed is TennCare's managed care?

In 1994 Tennessee moved virtually its entire Medicaid population and new eligibles into fully capitated managed care (TennCare). We analyze Tennessee's strategy, given limited existing managed care; and health plans' development of managed care infrastructure. We find signs of progress and developing infrastructure, but these are threatened by concerns over TennCare's financial viability and the state's commitment to TennCare's objectives. State policymakers seeking systems change need to recognize the substantial challenges and be committed to long-term investment.

Cost Control↗
PubMedDate not supplied

Managing Medicaid managed care: are states becoming prudent purchasers?

This paper examines the extent to which five states are becoming "prudent purchasers" in their oversight of Medicaid managed care. Our conclusions are mixed. These states are making more sustained efforts along these lines than most private purchasers are and have improved the amount and quality of the data they collect on the experiences of Medicaid clients when compared with the traditional fee-for-service program. They have been less successful in ensuring data quality that is adequate to support contracting decisions and in developing the analytical or political capacity to use data to "manage" the managed care system. Becoming a prudent purchaser appears to be a complex task for states that may prove difficult to achieve.

Contract Services↗
PubMedDate not supplied

Medical management after managed care.

Health insurers are under conflicting pressures to improve the quality and moderate the costs of health care yet to refrain from interfering with decision making by physicians and patients. This paper examines the contemporary evolution of medical management, drawing on examples from UnitedHealth Group, WellPoint Health Networks, and Active Health Management. It highlights the role of claims data, predictive modeling, notification requirements, and online enrollee self-assessments; the choice between focusing on behavior change among patients or among physicians; and the manner in which medical management is packaged and priced to accommodate the diversity in willingness to pay for quality initiatives in health care.

Cost Control↗
PubMed2002

Managed care or managed inequality? A call for critiques of market-based medicine.

This review article critiques the growing dominance of market-based medicine in the United States against the background of existing problems with quality of care, rising costs, devaluation of doctor-patient relationships, and, especially, persistent inequalities of access and outcomes. It summarizes the present state of health care delivery by focusing on the concurrent trends of growth in managed care, expanding profits, increasing proportion of those uninsured, and widening racial, ethnic, and class disparities in access to care. Allowing market forces to dictate the shape of health care delivery in this country ensures that inequalities will continue to grow and modern medicine will become increasingly adept at managing inequality rather than managing (providing) care. The article challenges anthropology to become more involved in critiquing these developments and suggests how anthropologists can expand on and contextualize debates surrounding the market's role in medicine, here and abroad.

Anthropology, Cultural↗
PubMed2004

Adequacy of glycemic, lipid, and blood pressure management for patients with diabetes in a managed care setting.

OBJECTIVE: We conducted a retrospective study to evaluate the adequacy of glycemic, lipid, and blood pressure (BP) management for diabetic patients in a managed care organization (MCO). RESEARCH DESIGN AND METHODS: Patients aged > or =18 years with diabetes (n=7,114) were retrospectively identified over a 2-year period from the MCO's administrative database based on the Health Plan Employer Data and Information Set 2000 selection criteria using pharmacy, laboratory, and encounter data. Analyses examined demographics and percentages of patients tested and meeting American Diabetes Association goals for HbA1c, lipids, and BP, both overall and for those receiving medication treatment versus no treatment. RESULTS: Testing rates for A1C, LDL cholesterol, and BP were 77, 54, and 95%, respectively. The percentage of patients tested who were at goal were 37% for A1C, 23% for LDL cholesterol, and 41% for systolic BP. Of the patients in our sample, 72% were treated for glycemic control, 64% were treated for BP control, and only 28% were treated for lipid control. Of the patients who received medication treatment, less than one-third were at goal for A1C (29%) and LDL cholesterol (32%), whereas 40% were at goal for systolic BP. CONCLUSIONS: We found that although a large percentage of diabetic patients were tested for A1C, LDL cholesterol, and systolic BP, a much smaller percentage had reached their respective goals. More aggressive glycemic, lipid, and BP management appears to be needed to improve care for these patients.

Adolescent↗
PubMed1994

Perceived gender roles of managers and effective conflict management.

This study examined the perceived conflict-management behavior and effectiveness of 45 managers who had been rated by 230 subordinates as representing masculine, feminine, or androgynous gender-role types. Analysis indicated that managers perceived by their subordinates as being androgynous were rated as better handlers of conflict situations than their masculine or feminine peers.

Adult↗
PubMedDate not supplied

Can managed health care help manage health care-associated infections?

Managed-care organizations have a unique opportunity, still largely unrealized, to collaborate with health-care providers and epidemiologists to prevent health care-associated infections. Several attributes make these organizations logical collaborators for infection control programs: they have responsibility for defined populations of enrollees and for their overall health, including preventive care; they possess unique data resources about their members and their care; and they are able to make systemwide changes in care. Health care-associated infections merit the attention and effort of managed-care organizations because these infections are common, incur substantial illness and costs, and can be effectively prevented by using methods that are unevenly applied in different health-care settings. Both national and local discussions will be required to enable the most effective and efficient collaborations between managed care organizations and health-care epidemiologists. It will be important to articulate clear goals and standards that can be readily understood and widely adopted.

Cooperative Behavior↗
PubMed1990

All managers are HR (human resources) managers.

Employee frustration and turnover may be partly due to management's reliance on the HR staff. HR professionals should share their expertise with other managers, so they can effectively deal with some of their own staff problems. Find out how to help your organization's managers improve communications with their staff and, ultimately, improve the bottom line.

Administrative Personnel↗
PubMed1990

Managed care: quality management differentiates the product.

Comprehensive quality management is a goal that requires major corporate commitment to implement and maintain. The best results in a quality management program will be achieved when all components are tied together in a comprehensive program. To do that, a significant investment in personnel and equipment is required. As the benefits of having a program such as the one as described above become more widely known and accepted, more and more managed care insurers and providers will adopt these or similar standards. The question, "How do you know that patients are getting high-quality and sufficient care?" cannot be answered today by insurers who do not have such a program.

Consumer Behavior↗
PubMed1994

How healthcare access management can facilitate an organization's approach to managed care.

Healthcare Access Managers can positively influence the success of their facility's interaction with managed care and recipients of services by applying their knowledge of sound business practices. Most managed care companies are eager to build these positive working relationships in their respective market areas. A positive approach can result in a win/win situation for all parties involved in the delivery of services.

Managed Care Programs↗
PubMed1994

Responding to health care reform: how managed health care providers can manage major change overload.

Multiple pressures for clinical, administrative, economical, and political change face providers today. To cope with a changing society and health care delivery system, change management skills have become essential for survival. However, implementing and managing organizational change demands a level of expertise that is, unfortunately, not readily found in many managed health care organizations. In this article, the author addresses the importance for providers to understand the process of change implementation.

Health Care Reform↗
PubMed1994

Implications of disease management in the future of managed care.

Disease management holds the promise of profound improvement in the care presently delivered to sufferers of specific diseases and provides the potential for a marked reduction in both short- and long-term health care costs. It has created an excitement that has formed new partnerships, caused managed care organizations to alter their focus, and encouraged the pharmaceutical industry to spend its wealth of resources on the total well-being of the patient. The authors address the somewhat ambiguous definition of disease management and examine the essential elements required to successfully implement programs of this nature.

Cost Control↗
PubMed1995

To manage or to be managed. This is a question?

Change is reality and the strategic decisions which are made by hospital leadership will largely determine the ultimate success or demise of an institution into this new world of managed care and capitation. There is no magic formula or right answer as to what an institution needs to do to survive and succeed. However, certain strategies can increase the likelihood of success in the inevitable future of riddled with so many unknowns. As a healthcare and hospital leader you can either manage your own destiny or be managed by the market forces which will inevitably be thrust upon you and your organization.

Economic Competition↗
PubMed1996

The angry physician--Part 2. Managing yourself while managing others.

One of the most difficult aspects of physician leadership is addressing angry colleagues. The first article in this series called attention to the problems that come with the Type A coping styles of many physicians and outlined strategies for managing oneself. Part 2 provides specific strategies that can be helpful in managing others' anger-generating behaviors and anger reactions. There are eight practical communication guidelines recommended by experts in the field for managing anger in others. They include: Strike while the "iron is warm." Match, then lead. Stay in your own zone. De-escalate the other's angry reactions. Do something different. Be assertive, not aggressive. Use effective negotiation tactics. Operationalize the problem.

Anger↗
PubMedDate not supplied

The physician manager. Practice management education in the 21st century.

Are physicians prepared to operate competitively for the 21st century? Not according to a recent survey completed by the Society of Physicians in Administration's (SPA) membership. In fact, as far back as the 1980s, physician surveys indicated that third-year physician residents and recent graduates felt their training in practice management was inadequate. Understanding practice management issues would improve a physician's chances for success. According to the SPA survey, however, most medical schools and residency training programs don't offer courses in management.

Attitude of Health Personnel↗
PubMed1998

Managed care at the crossroads: can managed care organizations survive government regulation?

Attorneys Brown and Hartung provide a comprehensive overview of the development and structural components of managed health care plans. The article discusses the state regulatory controls affecting managed care including Patient Protection Acts, mandated benefit provisions, any willing provider laws, and consumer access provisions. The article considers liability problems facing managed care organizations, in particular liabilities which arise from utilization and medical review discussions as well as gag clauses and financial incentive arrangements. The authors also review relevant federal regulatory initiatives.

Community Networks↗