Employers' liability risk for managed care injuries

Concerns about employer liability are a major public policy barrier to expanding tort liability for managed health care organizations. To evaluate the extent of these legal concerns, interviews were conducted with key informants, selected to represent a range of legal and demographic characteristics nationwide. These subjects reported a low level of existing concern about liability arising from managed health care, and few indicated that an increase in this threat would likely cause them to drop health benefits. Instead, most said employers would take a wait-and-see approach to theoretical liability threats and would consider responses short of dropping coverage, such as switching to fully insured health benefits, or from defined benefits to defined contributions.     

权威机构报告：中国银行业发展前景明朗

建国60周年的金秋之际,中国银行业协会和普华永道携手发布了《中国银行家调查报告2009》。这是双方首次合作对中国银行业进行的一次全面、深入的研究。这份报告反映了中国银行家对中国银行业改革开放、银行业务发展及银行业监督管理等方面的意见和建议,有助于我们了解中国银行业在当前国际金融危机背景下面临的机遇、挑战及应对之策;同时,也搭建了一座促进监管当局、国内外市场与中国银行业之间相互了解和沟通的桥梁     

Primary care physicians: increasing demand, shrinking supply

Any serious proposal for reforming the U.S. health care system must include a consistent, coherent national policy for increasing the supply of primary care physicians.     

Aligning managed care contracts, compensation plans, and incentive models

Today's pure production-based compensation and incentive models are lagging behind new, third-party, "value based" payment models, such as shared savings, bundled payments, and pay for performance. Financial executives are struggling with the emerging disconnects between new, external payment models and traditional methods providers use to distribute funds internally. To begin to align internal payment models with emerging third-party payment models, providers should inventory the misaligned incentives within their own organizations, engage their physicians and payers in a dialogue on what needs to be paid and how, and learn from past mistakes. No perfect payment distribution model exists. Rather, providers should choose a best-fit model based on their market position, culture, and readiness for change. Ultimately, finance executives should take the lead in aligning their organization's internal and external payment models.     

Flexible benefits and managed care: making it work

The concept of integrating flexible benefits and managed care may seem contradictory. Flexible benefits seek to maximize choice, while managed care attempts to restrict choice. Can these two disciplines be intertwined without delivering conflicting messages to employees? The answer is definitely yes. By following some basic ground rules in design, flexible benefits and managed care can be combined effectively in a way that is attractive to both employers and employees. This article presents some general guidelines for designing a successful "managed flex" program and raises other issues as well, including financial, administrative and communication concerns.     

Regulating managed care firms: the Connecticut plan

Virtually every state in the country, as well as the federal government, is either considering or has recently considered legislation to regulate utilization review/managed care companies. Despite the magnitude of this issue, few legislative bodies have expended the resources to study the form that regulation should take. Recently, Connecticut, which has seen considerable growth in utilization review within managed care programs that insure Connecticut residents, funded such a study. This article, authored by two of the study's participants, reviews the issues and explains the study's recommendations.     

Linking Internet strategy to high-quality, cost-effective managed care

This article describes an experimental pilot project incorporating e-commerce and the Internet into the traditional process of health benefit negotiations through the utilization of an HMO Internet auction. The timeline and process of the auction are described, with the final auction taking place during the last week of negotiations. The results reveal an efficient and effective system to augment the traditional benefit negotiation process.     

Hospital managed care diversification and reinsurance strategies

As increasing numbers of patients enroll in managed care plans, health care providers are faced with new operational and financial challenges. This article, the fourth in a series on the financial perils of managed care contracting, addresses issues related to diversification of risk and reinsurance.     

Measuring the savings from managed care: experience at Citibank

In a leap of faith, Citibank in 1989 designed a point-of-service plan aimed at containing health care costs in the long term without sacrificing quality of care. In 1994 a study was undertaken to empirically evaluate whether these goals had been achieved. The study supported Citibank's overall managed care strategy, providing objective, quantifiable data that can lead to greater efficiencies.     

The impact of the managed care backlash on health care spending

The health spending slowdown associated with the managed care revolution in the 1990s suggests that managed care may have been successful in controlling health care spending. I exploit the passage of state regulation during the “managed care backlash” as well as geographic variation in managed care intensity to measure the impact of managed care on spending. I find that restricting managed care causes a large and significant increase in hospital spending, which cannot be explained by changes in hospital market concentration, other regulatory activity, and multiple other possible explanations. I also do not find effects of the backlash on mortality.     

Knowledge,risk and Beck: Misconceptions of expertise and risk

Ulrich Beck's work is beginning to alter how risk is understood. This paper maps out the core of Beck's argument and provides a critique of his analysis. In particular it argues that this emerging concept of risk is flawed because it is not rooted in an ontological view of knowledge and, hence, it misunderstands the relationship between experts, expert knowledge and lay knowledge. Because of his downgrading of ontology, Beck under-theorizes the politics of expertise and the sociality of knowledge hence we should be cautious in our use of his analysis of risk and organization in late modernity.

It has been said civilization is a race between education and catastrophe. With Katrina, we have had the catastrophe, and we are racing inexorably toward the next. Americans want to know; what have we learned?

(US Select Bipartisan Committee, 2006; ix)

     

The history of employment-based health insurance: the role of managed care

The author describes the history of how the employment-based health benefits system has evolved. Specifically, he examines how we got where we are today, the success of managed care, the shortcomings of the managed care system and challenges that the managed care system will face in the future. He concludes that, despite substantial improvements in the quality of medical services provided, employers have a long way to go before they are truly purchasing the highest quality health care at the most efficient prices.