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At least 667 records · Page 37Linked to original sources
PubMed1991

Design of legal audits for utilization management.

Liability for managed care risks, the enactment of detailed state regulation of utilization management and the process requirements of accreditation agencies and managed care customers all create the need for new approaches to legal auditing. Concepts from industrial quality management theory can be used to define process elements that serve the legal adequacy of the utilization management process. The information systems that record information gathered and judgments made by reviewers and generate basic notices of certification can be designed so as to produce data relevant to compliance and liability management. These key process elements then can be analyzed statistically to develop plans for preventive counseling.

Contract Services↗
PubMed1992

New PHO (physician hospital organization) concept eliminates middleman.

Four Denver-area hospitals are adding a new twist to the physician hospital organization concept, banding together to form "The Healthcare Initiative." This new coalition provides these independent institutions with the cost-containment and physician-control benefits of PHOs, while allowing a wider geographical service area. Such arrangements, however, require special information systems planning.

Colorado↗
PubMed1993

Managed-care systems tackle new territory.

The vital application of managed-care information systems is in contract management. Ten products now on the market have the potential to streamline this function. These contract-management systems range from standalone workstations to new modules built into the hospital information systems. CIH Contributing Editor Walter Wieners gives their advantages and disadvantages, and tells the best way to decide which system is right for your organization.

Catalogs, Commercial as Topic↗
PubMed1993

Case management a must to survive managed care.

Fast, efficient access to patient information is now an essential management tool. Not only does it facilitate a streamlined approach to the continuum of care, but it also helps ensure the kind of quality that consumers are clamoring for.

Continuity of Patient Care↗
PubMed1993

Information technology boosts managed care's 'bottom line'.

Too often physicians, clinics and hospitals affiliated with managed-care organizations pick up the tab for procedures that should be considered shared risk. Information systems can save millions if they're geared toward catching these billing faux pas.

Computer Communication Networks↗
PubMedDate not supplied

Rate structuring in managed care contracts demands detailed information.

In summary, managed care contracts are being written in a variety of ways, versions of capitation and discounted fee-for-service being only two of them. If you can't generate all of the information needed to negotiate, you need to step back and take another look at your management information system. Managed care is here. It was "just around the corner" yesterday!

Capitation Fee↗
PubMed1993

Southern California Edison's performance standards: an employer's key to quality care delivery.

One of the most significant lessons learned from this process is that setting objectives with performance standards is the key to continuous quality improvement. The critical differences between health administration and health management are threefold: (1) performance standards are developed with clarity, (2) care delivery is monitored and measured against these standards, and (3) improvements are made based on information from these measurements.

California↗
PubMed1994

HotList. Case-management tools.

March's HotList features information systems designed to assist case managers. All data have been provided by individual vendors who responded to survey questions. Health Management Technology has made an effort to contact all vendors within this market. Of 213 vendors contacted, 26 responded as offering case-management-tool products. A full contact list may be requested by contacting HMT Editorial at (303) 220-0600. See the 1994 Health Management Technology Market Directory for complete listings.

Catalogs, Commercial as Topic↗
PubMed1994

Meeting the information system demands of the future through outsourcing.

As managed care organizations work to meet the rigorous data and information requirements of a rapidly evolving health care system, many are recognizing the need to out-source their computer operations. Developing a cost-effective, efficient approach to outsourcing is a challenge to many organizations. This article offers an in-depth view of outsourcing as it relates to the managed health care industry as well as criteria for selecting an outsourcing consultant or vendor.

Competitive Bidding↗
PubMed1994

Health care reform's effect on home care: strategies for survival.

Home care is expected to thrive under President Clinton's health care reform proposal, growing from a $12.1 billion business in 1995 to $18.8 billion by the year 2000. While the home care industry grows, both public and private payers will be increasing their interest in reviewing home care services provided and billed. Home care companies must prepare for a future that includes increased interaction with managed care plans. In this article, the authors discuss strategies for home care providers to succeed in a managed care environment.

Capitation Fee↗