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A primary care approach to the infertile couple.

BACKGROUND: Approximately 20% of reproductive age couples have difficulty conceiving or maintaining an established pregnancy. The family physician is in a unique position to provide patient education, begin initial evaluation, make appropriate referrals, and offer ongoing counseling and support to couples who experience problems with fertility. METHODS: And extensive clinical review was conducted based on a MEDLINE search, the Cochrane database of systematic reviews, and other supporting evidence. RESULTS: Major physiologic influences affecting live birth rates include age, coital frequency, and duration of infertility. Male factor is associated with approximately 40% of these cases and should be addressed early in the evaluation. CONCLUSION: Many conditions once considered untreatable can now be routinely corrected. As managed care programs expand coverage to include infertility services, primary care providers will be asked to participate in the initial phase of this care. This article offers a practical approach.

Abortion, Habitual↗
PubMed2001

Managed care HotList.

Explore the source record for details and available documents.

Catalogs, Commercial as Topic↗
PubMed2001

Assessing an IDS's readiness to operate profitably under a risk contract.

An IDS that wishes to assume risk should understand first the factors that have caused IDSs to experience poor financial performance under risk contracts. Then, the IDS should clarify its goals for managed care contracting, assess its operational strengths and weaknesses, evaluate potential managed care payer partners, and understand the amount of risk associated with various contract options. Implementation issues that need to be addressed include aligning the financial incentives of physicians and the IDS, establishing systemwide policies and procedures for monitoring performance, and developing information systems capabilities.

Contract Services↗
PubMed2001

Beyond connectivity: what the success of one health plan's e-solution means for the future of the healthcare industry.

This article highlights the statewide success and rapid acceptance by providers in North Carolina of PARTNERS National Health Plan's implementation of a multipayer Internet connectivity solution for providers, employers, and members. PARTNERS is a premier health plan in North Carolina that covers more than 400,000 lives. The company introduced on-line communication to their network of ten thousand providers and has seen the number of on-line users and interactions grow by approximately 25 percent a week to represent more than two thousand providers in the first six months of roll-out. Providers can now look up eligibility and benefits and review and submit claims and referrals on-line; soon they will be able to order and review lab results and perform prescription management. PARTNERS found their Internet solution in HealthTrio's Intelligent Connectivity, which allowed them to create Internet communications without replacing back-end office solutions.

Consumer Behavior↗
PubMed2001

Structuring a central business office to succeed in a managed care dominated environment.

Integrated delivery systems have begun to consolidate the business office functions of their member facilities in response to a decline in managed care revenues and an increase in health care expenses. Many who have pursued this strategy have experienced cost reductions through staff restructuring, but have not experienced the revenue retention, cash acceleration, and other performance gains originally envisioned. This often occurs when the role of the central business office (CBO) has been limited to serving only the "back-office" functions of claims processing. In today's health care environment, the viability of a CBO depends on its responsiveness to the administrative complexities of managed care. Successful CBOs accommodate extensive cross-functional coordination, achieve operational efficiencies through the use of automation, and adopt best practices for implementing managed care contractual obligations.

Benchmarking↗
PubMed2001

The case for dental preferred provider organizations.

The dental PPO market is the fastest growing segment of the dental benefits business. As with traditional indemnity plans, dentists are reimbursed on a fee-for-service basis. Members can refer themselves to dentists of choice, including specialists, inside and outside the network. Employers' interest in DPPOs is expected to continue as they seek to control or reduce expenses associated with dental benefits plans. Dentist participation in managed care programs significantly lags medical, and fewer than half of practicing dentists participate in DPPOs. Negotiated discounts vary across carriers and geographic regions, generally ranging 15% to 30% off average fees. The American Dental Association predicts that dentists' participation in DPPOs will continue to increase, indicating further growth for these dental plans. There are financial incentives for members to stay in network.

Health Benefit Plans, Employee↗
PubMed2001

Next phase of medical management systems: automating administrative transactions to integrate payors and providers.

Today, medical management is burdened by the cost and hassle of manual administrative tasks. Manual intensive processing (that is, phone and fax) of referral requests and institutional authorization transactions results in significant unnecessary costs for the providers and payors, delays in approval, and problems with errors. To address these administrative burdens, the next phase of online (Internet- and wireless-enabled) medical management applications will focus on the administrative and transaction side, including self-service referral and authorization processing between the payor and provider. The advent of the Health Insurance Portability and Accountability Act (HIPAA) greatly improves the ability to gain widespread adoption of these online applications thanks to mandated standardization of many routine transactions. This article explores this next phase of online administrative and transaction medical management applications from the payors' perspective and explores their connectivity with providers. Payors are striving to meet several objectives as they implement these online administrative and transaction medical management systems: reducing the administrative burden and cost, changing traditional medical policies, increasing provider adoption of connective technologies, addressing HIPAA compliance, and achieving higher levels of system integration.

Computer Communication Networks↗
PubMed2001

The criminalization of adults with mental illness (Part 1).

In Part 1 of "The Criminalization of Adults with Mental Illness," we have identified the major factors contributing to the criminalization of the mentally ill as being deinstitutionalization (and the related underfunded, under-coordinated recommendations of the Joint Commission on Mental Illness in 1961), the sometimes overly restrictive legal protections, and states' implementation of usually underfunded Medicaid managed care programs. Subsequent papers will describe and discuss Tennessee statistics relative to criminalization of the mentally ill (Part 2) and will introduce methods for preventing criminalization of mentally ill adults and the maintenance of mentally ill individuals who have committed minor crimes in their respective communities.

Adult↗
PubMed2002

Managed care hotlist.

Explore the source record for details and available documents.

Catalogs, Commercial as Topic↗
PubMed2002

Integrated, automated revenue management for managed care contracts.

Faced with increasing managed care penetration and declining net revenue in recent years, healthcare providers increasingly are emphasizing revenue management. To streamline processes and reduce costs in this area, many healthcare providers have implemented or are considering automated contract management systems. When selecting such a system, healthcare financial managers should make certain that the system can interface with both patient-accounting and decision-support systems of the organization. This integration enhances a healthcare provider's financial viability by providing integrated revenue-management capabilities to analyze projected performance of proposed managed care contracts and actual performance of existing contracts.

Accounts Payable and Receivable↗