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As providers consider creating health plans to offer services to Medicare beneficiaries, some are discovering that the required investment in information systems could make profitability tough to achieve.
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The main drawback to contact capitation has been its administrative complexity. Now, a San Francisco managed care firm has released an Internet-based system that offers a simple process for determining contact values and payment amounts.
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This article uses Medicaid claims data to examine the adequacy of well-child care provided by different ambulatory care providers for selected children enrolled in Maryland Medicaid. Considerable provider variation was observed. The majority of the nearly one-quarter of the children with no well-child visits during the year appeared to have had no regular primary care source. Results contributed to the development of a managed care program designed to increase care accessibility and continuity and improve provider practices. Advantages and disadvantages of using claims data to investigate this public health issue care discussed.
Selecting a managed care system in the absence of a clearly defined business strategy is like driving across the country without a road map. But SelectCare didn't let that stop them. Here's their seven-step methodology.
More organizations are developing interactive Web sites that go beyond simple billboard-like advertising. These hospitals, integrated delivery systems, physician group practices and managed care organizations are finding that interactive Web sites are helping them improve service for a modest cost.
In this case study, a real-life information technology conundrum is fictionalized to illustrate the potential benefits of retaining corporate knowledge through the creation of an information repository in a managed health care plan.
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Today's product innovations reflect hospitals' need to maximize revenues from managed care contracting. They were designed in response to the facts of the contracting environment: That hospitals are more likely to be paid when their pre-admissions procedures are true to their contractual terms. That they are more likely to be paid fully when they have automated tools to assist accurate billing proration and receivables management. And that hospitals are more likely to negotiate profitable HMO and PPO contracts when their negotiators have timely information to determine the financial implications of contract terms.
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Physician leadership extends beyond traditional clinical disciplines to hospital administration, group practice management, health policy making, management of managed care programs, and many business positions. What kind of person makes a good physician executive? What stands out as the most important motivations, attributes, and interests of high-performing physician executives? How does this compare with non-physician health care executives? Such questions have long been high on the agenda of executives in other industries. This article builds on existing formal assessments of leadership attributes of high-performing business, government, and educational executives and on closer examination of health care executives. Previous studies looked at the need for innovative, entrepreneurial, energetic, community-oriented leaders for positions throughout health care. Traits that distinguish excellence and leadership were described by Brown and McCool.* That study characterized successful leaders in terms of physical strengths (high energy, good health, and propensity for hard work), mental strengths (creativity, intuition, and innovation), and organizational strengths (mission orientation, vision, and entrepreneurial spirit). In this investigation, a subset of health care executives, including physician executives, was examined more closely. It was initially assumed that successful physician executives exhibit many of the same positive traits as do nonphysician executives. This assumption was tested with physician leaders in a range of administrative and managerial positions. We also set out to identify key differences between physician and nonphysician executives. Even with our limited exploration, it seems to us that physician executives probably do differ from nonphysician executives.
Healthcare organizations adopt HIMS to manage the large amount of data available in the patient medical record. The CPR, however, must be more than a mirror image of the paper record to yield analyzable data necessary to answer the consumer's questions about cost and quality of care. Although organizations strive to achieve standardization of medical recording required for analysis, they must also be attuned to factors necessary to achieve end-user compliance and comfort with data input. The closer organizations move to ease of conversion to computerized medical records, the further they may be moving away from data integrity. What is more, the optimal balance point may be different for each organization.
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Explore the source record for details and available documents.
Explore the source record for details and available documents.