TABLE OF CONTENTS:
Introduction
CHAPTER 1: GENERAL
MANAGED CARE TRENDS
- Recapping Topics that Pushed
Managed Care's Hot Buttons
- Census Bureau Reports Decline
in the Uninsured
- AARP Report: Dissimilarities
Among States
- Staff Model HMOs Get Lowest
Rating for Primary Care
- PPOs: Enrollment Up,
Popularity Increasing
- Findings Show HMOs Lost
500,000 Enrollees Between January and July 1999
- No Discrimination Found in
HMO/Non-HMO Admit Rate
- Americans Don't Understand
Managed Care
- Managed Care Professionals'
Salaries Are Up — Way Up
CHAPTER 2: MERGERS AND
ACQUISITIONS: AN INDUSTRY UNDER CONSOLIDATION
- PMGs Lead in 3Q 2000
M&As; PPMs Are Reverting Back to Original Owners
- Managed Care M&As
Take Steep Nose Dive
- MCO Mergers Facing Strong
Opposition
- Consolidation Continues for
Managed Care
- Consolidation Helping HMOs
Return to Profitability
CHAPTER 3: EYE ON
MANAGED CARE FINANCIAL TRENDS
- As Predicted: Healthcare
Costs Are Rising
- Healthcare Cost Increases
Were Expected to Double in 1999 — Americans Concerned With
the Effects
- Provider Reluctance To
Negotiate Causes Medical Inflation Rate To Reach Double Digits in 1999
- Unexpected Surge in Managed
Care Enrollment Held National Cost Increase to 0.2 Percent in 1997
- HMO Profits Are Improving
- MCOs Retain a Larger Portion
of Overall Revenues
- Quarterly Analysis Shows HMOs
Generally Performed Better in 1998 than in 1997
- Lending Institutions Say
"Nay" to Healthcare Trade
- S&P Outlook:
Industry's Secure
- Fourth Quarter 1999 Prices
Up; Year-to-Year Prices Decline
CHAPTER 4: COST
CONTAINMENT: MAKING THE MOST OF HEALTHCARE DOLLARS
- Blending PPO Flexibility With
HMO Cost Controls Proves Beneficial
- Study Identifies Average MCO
Expense Ratios
- Poll: If MCOs Ditch Cap,
Would They Lose Control?
- U.S. Hospitals Are Broke,
MCOs Tactics to Blame
- Ensure Profitability by
Re-Evaluating Your Management of Medicare Revenue
- Improve Profitability by
Managing Injury and Work-Related Claims
- Better Care for Depressed
Saves Money
- Healthcare Companies Partner
to Battle Fraud
CHAPTER 5: THE MANAGED
CARE BACKLASH: AN INDUSTRY UNDER FIRE
- Government-Appointed Task
Force Suggests Improvements
- New York Plans Work To
Improve Managed Care Image
- Much Attention Given To Few
Managed Care Complaints
- Finding the Villain in the
Health Insurance Blame Game
- Accusations Point to MCOs'
‘Retrospective Review' Tactics
- HMO Stereotypes Influence
Consumer Ratings of Their Healthcare
- "Feelin' Good" Ad Campaign
Focuses on Customer Service and Positive Attitudes
- Lawsuits Raise Issues With
Health Plans' Business Practices
- Forms No More!
- Why More MCO Physicians Need
To Join Medical Societies
CHAPTER 6: MEMBER
RETENTION: STRATEGIES TO MAINTAIN SUCCESS
- How To Keep Your Customers
Happy
- Three Reasons Cited for
Managed Medicare Disenrollment
- How To Increase Retention,
Loyalty
- Providing Requested
Medications: One Way To Maintain Satisfaction
- Increase Satisfaction By
Letting Consumers Have Their Say
- AAPPO Launches Campaign To
Explain Advantages of PPOs
CHAPTER 7: BEST
PRACTICES: SERVING THE MANAGED CARE CONSUMER
- Study Examines HMO Customer
Satisfaction Levels
- Survey Shows Consumers'
Perceptions of Healthcare System
- Majority of HMO Members Still
Reporting Overall Satisfaction
- Survey Compares Trends in
Satisfaction and Identifies Top HMOs
- Anthem BCBS Targets Women's
Health Issues
- CIGNA HealthCare Improves
Care for Women: Program To Cover Cancer Screenings
- Blues Board To Draw Attention
to GA Women's HealthIssues
- Second Humana Service Promise
Provides Round-the-Clock Assistance
- Aetna Targets College
Students Searching for Healthcare
- Enrollees Are Served Better
by Not-For-Profits
- The Effectiveness of a
Marriage Between an HMO and Wellness Program
- MCOs Reaping the Benefits of
Health and Wellness Programs
- Blue Shield of California
Offers Free Online Healthcare Services
- Health Plan Reaches Out to
Community Through Educational Initiative
CHAPTER 8: MAKING
MANAGED CARE WORK
- One Plan's Demise Doesn't
Equal Another Insurer'sRise
- Future Challenges for Managed
Care Claims Processing
- Understand Why, How and With
Whom to Outsource Your Business Functions
- Taking Control of Managed
Care Risks and Liabilities
- CNA Offers Strategic Advice
To Deal With Liability Issues
- Ensure Consistency When
Defining Medical Necessity
- Caring for Healthcare's
Majority — Addressing Women's Needs
- PacifiCare Restructures,
Three Divisions Created
- Managed Care Directory
Provides Market Research, Benchmark Analysis
CHAPTER 9: EXAMINING
MANAGED CARE BENEFITS
- New Study Shows Severe
Decline in Behavioral Healthcare Benefits
- Changing Times: MCOs Offer
Mental Health Benefits Most Often
- Number of MCOs Offering
Psychiatric Benefits Doubles in Pacific Region
- Depression Treatment Leaves
Something To Be Desired
- Chiropractic Benefits More
Likely in Rural MCOs
- Vision Benefits Less Common
Among MCOs in Densely Populated Regions
- Dental Benefits Move to
Managed Care
- One in Five MCOs Covered
Workers' Comp
- Number of MCOs Covering Home
Health Grows by 60 Percent
CHAPTER 10:
COMPLEMENTARY AND ALTERNATIVE MEDICINE: NEW TREATMENT METHODS IN
MANAGED CARE
- Complementary and Alternative
Medicine: Consumer and Physician Attitudes Examined
- HMOs Moving To Integrate
Alternative Care
- Consider a Supplemental Rider
When Offering CAM Benefits to Enrollees
- Supplemental Rider Most
Popular for CAM
- A Working CAM Model: An
Administrative Perspective
- How To Integrate CAM Into
Your Program: An Administrative Perspective
- MCOs Can Build Chiropractic
Networks Faster
CHAPTER 11: DISEASE
MANAGEMENT: IMPROVING LIVES, REDUCING COSTS
- Association Helps Clarify DM
- Cost-Effective/Clinically
Oriented Programs
- Disease Management a Plus,
But More Can Be Done
- Disease Management Company
Expands Managed Care Services
- NYLCare Finds Success with
Disease Management Program
- Programs Successfully Target
Congestive Heart Failure
- Innovative Program Attacks
Asthma and Other Respiratory Diseases
- Smoking Cessation Designed
for All Groups and Ages
- Pharmacy-Level DM Program
Nets 25.4 Percent In Savings for CIGNA
- Conference Highlights the
Questionables of Online Disease Management
CHAPTER 12: MANAGED
CARE PHARMACEUTICAL ISSUES
- United Healthcare Revamps
Pharmacy Benefit
- Rising Pharmaceutical Costs:
Examining Causes, Effects and Changes to the System
- Despite Changes/Restrictions,
Enrollees Rate Pharmacy Benefits Highly
- Plans To Benefit From
Pharmacy Web Sites
- American Pharmacy To Aid
Japanese Counterparts
CHAPTER 13: THE
EMPLOYER SIDE TO MANAGED CARE
- Taking a Look at Healthcare:
The Employers' Perspective
- Employers Improving
Healthcare Through Value-Based Purchasing
- Movement to Value-Based
Purchasing Hindered by Six Obstacles
- Rise in Healthcare Costs Puts
Direct Contracting Back on the Table
- Sifting Through the
Assortments in Employer-Sponsored Health Insurance
- RU-486: Covering it Pushes
Ethics and Politics Aside
CHAPTER 14: LEGISLATION
AND REGULATION
- HIPAA Will Have Major Impact
on Healthcare Industry
- HIPAA Transaction Regs
Finalized; Plans, Providers Will Be Scouting Vendors
- Can You Hear the Clock
Ticking? 2001 and HIPAA: A Health Odyssey
- How To Prepare for HIPAA
- Regulatory Challenges Facing
HIT Companies
- The Dynamic Dozen: Some Top
Resources for HIPAA Information
- Professionals Doubt
Legislators' Ability To Fully Understand the Healthcare System
- HCFA Addresses National
Coverage Decisions
- MCOs Need To Prepare for
Risk-Based Capital Requirements
- Wide Variations in PPO
Oversight, A Comparison of States Reveals
- Physicians and Other
Providers Could "Unionize" Under Bill
- Bill Would Require Permission
To Record Phone Calls
- Bill To Protect Managed Care
Customers
CHAPTER 15: MEDICARE
AND MEDICAID MANAGED CARE
- The Implications of Medicare
Reform on the Healthcare Market
- Medicare+Choice Adds More
Choices for Enrollees and Fuels Competition Among Health Plans
- Face-To-Face Q&A
Meetings for Medicare Enrollees
- Manage Care and Reduce
Utilization To Succeed in Medicare
- Ensuring Success in Medicare
Risk
- Risk Adjustment Gives MCOs
Higher Medicare Premiums
- Beneficiaries With Cancer Get
Better Care from HMOs
- CIGNA Not Alone in Medicare
Withdrawals
- Managed Medicare Member
Retention Affects More Than Balance Sheets
- OIG To Take Another Look at
Medicare Managed Care Marketing Materials
- Medicaid Misperceptions: What
Can Be Done To Change Them?
CHAPTER 16:
MCO-PROVIDER RELATIONS
- MCOs Beef Up Contracting To
Meet Demand for More Comprehensive Network
- MCOs Should Improve PCP
Contracts
- Coastal Regions Home to
Largest IPA-Model HMOs
- Regional Analysis Shows
Prevalence of MCO-IDS Affiliations
- Antitrust Controversy Pits
MCOs Against Docs (Again)
- Court Ruling Opens the Door
for Physicians' Contract Disputes
- Data Shows Managed Care
Prevalence in Physician Organizations
- Trends in HMO-Physician
Reimbursement
- Fewer Referrals From PCPs
Could Be Taking Its Toll
- MCOs Should Have Helped Row
the Boat, Before They Jumped Ship
CHAPTER 17:
PHYSICIAN-PATIENT RELATIONS
- Improve Healthcare Services:
Break Physician-Patient Communication Barriers
- Physicians Working To Improve
Patient Relationships
- Managed Care Physicians Must
Address the Age of Consumerism
- Study Champions Primary Care
Physician's Role in Specialist Referrals
CHAPTER 18:
ACCREDITATION: MEASURING THE QUALITY OF MANAGED CARE
- Keeping Up With Accreditation
- Accreditation Organizations
Form New Group To Combine Efforts
- Reporting HEDIS —
Health Plans Face Information System Problems
- NCQA's HEDIS 2000 Targets
Care for Chronic Diseases
- URAC Accreditation Highest
for PPOs in Pacific Region
- URAC To Develop Flexible
Ranking System
- NCQA To Refine Accreditation
Program; Aim Is Patient Safety
CHAPTER 19: QUALITY
ASSURANCE: ENSURING THE BEST POSSIBLE CARE
AHRQ Targets Health Outcomes and Quality
Consumers' Assessments of Medicare Plans Online
Healthcare Execs Split Over Having Only One Quality Oversight Body
Study Shows Link Between Cost and Quality
PacifiCare's Report Drives Quality Among Physicians
NY HMO Plans Earn Passing Report Card Grades
URAC Defines Three Categories of PPOs
Managed Care Outperforms FFS, Study Shows
CHAPTER 20: TECHNOLOGY
TAKING A STRONGER ROLE IN MANAGED CARE
- Survey Examines Medical
Management and Data Analysis Opinions
- Healthcare Organizations Need
To Plan for Disaster Recovery
- Address IT Issues Before
Entering Any Healthcare Merger
- Kaiser Awarded for Efforts in
Computerized Patient Records
- AAHP Approves Initiative To
Guide Health Plans' E-health Activities
- URAC Appoints Members of
Health Web Site Advisory Committee
- How To Ensure Your Web Site
Is Not a Liability
- Aetna U.S. Healthcare Moves
Toward Paperless Claims Processing and Referrals
- Technology Cited As Top
Method To Improve UR
- Electronic Medical Records
— Should They Be an Industry Standard?
- HealthLink America Measures
Patient Satisfaction
- Community Profiling Aids in
Strategic Marketing
- Online Marketplace Created
For MCO Executives
- New Jersey Healthcare Members
To Benefit From Internet Service
CHAPTER 21: LOOKING
AHEAD IN MANAGED CARE
- PPOs, HIPAA and Online DM Are
Among the Top Trends for 2001
- Top Trends for Managed Care
in 2000
- Healthcare Expenditures
Rising: 10 Year Prediction Calls for Twice as Much Spending
- How To Integrate Successfully
for the 21st Century
- Looking Ahead: Future Trends
in Managed Care
- Rising Premiums Are Not the
Only Concern on the Healthcare Horizon
- Experts Give Some Healthy
Advice to the Managed Care Industry
- A Call To Arms Against
Medical Errors
- Consumers Willing To Pay Fee
and Switch Health Plans for Online Health Services
- PPOs Are Increasing in
Popularity
- Study Shows Effects of
Managed Care Growth on the Hospital Community
- Help Wanted: New-Aged Medical
Director Leadership
CHAPTER 22: MARKET NEWS
- Market Partnerships
- Contracts Awarded
- Acqusitions
- Consolidations
- New Managed Care Products
- New Market Expansions
- Network Creations
- Network Developments
- Certifications
- Strategic Plans
- Deals Undone
- MIS
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