Managing managed care

Managed care creates several dilemmas for the physician executive. Effective management is hindered by lack of analytical tools that stem from current limitations in outcomes research and treatment protocols, altered financial incentives that are controversial and that seem at odds with traditional incentives, and values that create conflict between the needs and expectations of individual patients and populations or groups under managed care. The executive must manage a process that resolves apparent conflict in an explicit ethical framework that acknowledges the limitations of data, with full awareness of the potential conflict between financial incentives and clinical judgement.     

Beyond managed care

Even as the federal government tries to prop up Medicare managed care, HMOs continue to pull out of the program. But a Centers for Medicare & Medicaid Services demonstration project aims to show that one concept of managed care can keep chronically ill patients healthier and lower overall costs. The concept, coordinated care, blends case management and disease management, giving patients the resources to manage their own care more actively. But, please, just don't call it managed care.     

Electronic managed care: the utilization of information technology in a managed care environment

Health care managers must use information technology in managed care negotiations with all players in the managed care model-employers, managed care organizations, providers, and patients. Information technology effectuates these negotiations, provides a value added to all those involved in terms of efficiency and communication, and helps managers remain within regulations. This article describes each phase of the managed care model and how information technology is used. It also provides an operational overview of how to integrate the technology into health care settings.     

Medi-Cal managed care

Managed care programs may give California communities a cost effective way to provide health care to a growing Medi-Cal population. In this issue California Hospitals explores the benefits and risks of these programs.     

Medicaid managed care

Managed care plans that successfully deliver services to low-income populations say the first challenge can be the toughest: gaining potential enrollees' trust. Without it, they won't seek timely care or follow treatment instructions. That done, several care management strategies, including prevention and provider incentives, hold the key to keeping costs down and enrollment up, agree leaders at seven established Medicaid plans interviewed by HSL.     

TennCare: managed care or managed financing?

Tennessee's troubled experience in shifting 1.2 million Medicaid beneficiaries into managed care virtually overnight has important lessons for other state governments and health systems.