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At least 685 records · Page 38Linked to original sources
PubMed1994

Hunting for data to limit risks of managed care.

As managed care ignites market after market, hospitals and health systems are turning to computer software to help collect the right payments and control the use of resources. Our Nov. 7 issue detailed how providers were using the classic number-crunching capability of computers to bill according to complex formulas in managed-care contracts. This article looks at how computer software is evolving to handle management of defined populations under predetermined reimbursement.

Cost Control↗
PubMed1995

Customer complaints: a managed care firm's best weapon in CQI.

Encouraging customer feedback and developing an automated customer complaint system are two essential steps a health plan must take if it wishes to develop a balanced relationship with the customer. The author explores how the right attitude and appropriate action can ensure that both customers and the company reap the benefits of a comprehensive customer complaint system.

Boston↗
PubMed1994

Blueprint for one perfect day.

Managed care will force you to be more efficient in hundreds of ways in your office day. Here's a proven system for meeting that challenge--a system that will pay dividends in office morale and patient satisfaction.

Efficiency, Organizational↗
PubMed1995

Bringing clinical accuracy to provider profiling systems.

Traditional provider profiling systems have difficulty accounting for the wide-ranging differences between patients, their conditions, and the physicians' practices. However, new technologies and methodologies that can extract the needed information from existing data sources offer a means of accurately and efficiently comparing the performance of providers, specialties, networks, and other elements of managed care organizations. Profiling can strengthen the bonds of trust between the providers and the managed care organization, making them partners in delivering quality care.

Algorithms↗
PubMed1995

State perspectives on health care reform: Oregon, Hawaii, Tennessee, and Rhode Island.

The general consensus among States which have had their section 1115 demonstration projects approved is that there is no one best way to implement State health care reform. The Health Care Financing Administration (HCFA), however, wished to discern how States were accomplishing the task of implementing the demonstrations, and solicited responses from State representatives whose section 1115 demonstration waivers had been approved. The resulting article gives an overview of this implementation process from four State perspectives. Written by representatives from Oregon, Hawaii, Tennessee, and Rhode Island, the ideas presented here are indicative of the complex undertaking of State health care reform.

Centers for Medicare and Medicaid Services, U.S.↗
PubMedDate not supplied

Who's minding the data: information system requirements for participating in at-risk contracts.

Managed behavioral healthcare organizations that receive capitated payments to provide behavioral healthcare services for a defined population need sophisticated management information systems that allow for two-way data exchange with payors. Such systems must be able to generate data on cost per service and utilization of services by beneficiary population, while incorporating a number of subsystem capabilities. In this article the author reviews the requirements for such an information system, the various potential financial loss points that have made such capabilities essential and the specific features that are demanded--as well as offering suggestions on how to select an information system vendor.

Capitation Fee↗
PubMed1995

The importance of management information systems in a managed care environment.

Keys to successful information systems for home care providers are planning and control. With managed care's emphasis on data, agencies need to have information systems that can handle the demands managed care puts on agencies today--planning before hurrying to install a system will ensure control as the managed care contracts add up.

Contract Services↗
PubMed1995

Improving customer satisfaction: emerging lessons about strategy and implementation, Part 2.

This article describes a six-phase strategy designed to systematically improve customer satisfaction across an entire managed care system. Part 1 (Spring 1995) of this two-part series summarized the theoretical underpinnings of the approach and highlighted the first two phases of the improvement strategy. Those phases involve systematically listening to the organization's customers and using customer information to strategically target key areas for improvement. This article describes the specifics of the last four phases of the strategy; these phases involve achieving and sustaining unprecedented levels of improvement in targeted areas. Initial results and emerging lessons associated with the implementation of this strategy are summarized.

Leadership↗
PubMed1995

Rethinking revenue collection at military MTFs (medical treatment facilities).

Military medical treatment facilities (MTFs) throughout the nation have felt the impact of the dramatic transition from traditional fee-for-service health insurance coverage to managed care programs. Some facilities have had to struggle to survive. Yet one facility, the Naval Medical Center-San Diego, San Diego, California, nearly doubled its revenue collections in spite of a reduction in billable claims, reduced staff, and a substantial increase in non-billable policies.

California↗