Managed Care



Information on the managed care industry, control of health care costs & quality in medicine. Health plan ratings. Accreditation lists/report cards. Benchmark medical fees - average cost by DRG/ICD-9 code. Practice management resources. Cost, quality & liability issues. State regulation of managed care. Medical outcomes assessment and research studies.

Also refer to Categories: Health (all) Legal - Health Law. Medicine (all) Organizations - Health, Occup Medicine, Medicine. Publications - Health, Occup Medicine, Medicine. Regulations - CMS, Health, Insurance. Risk Mgt - Medical Liability. Safety - Needlesticks. Security - Health Fraud, Medical Privacy. Statistics - Health, Insurance, Mortality.USA Government - Center for Disease Control, Health & Human Svcs, National Institute of Health.

Education

Seminars, conferences, symposiums and training sessions on managed care topics.

Health Plans

Checkpoint comparisons of managed care health plans. American Association of Health Plans. Integrated Healthcare Association - California. What health plans should know about Clinical Practice Guidelines. Managed care requirements in Medicare and Medicaid.

Issues

Covers the issues related to the management of medical costs versus the quality of care being provided.

Liability

Various resources assist the physician in understanding liability in managed care. The Health Administration Responsibility Project (HARP) - seeks to establish liability of managed healthcare organizations for consequences of their decisions. MCO's - the rules are changing for managed care liability.

Library

Headline news on managed care. Managed care glossary. Managed care contracting. Cost and quality issues. State regulation of managed care. Newsletters. Statistics. Tutorials. Fact sheets.

Medical Costs

Average cost by DRG. Benchmark medical fees. Predictors & descriptors of psychiatric duration, costs and service use. Trends in length of stay, charges and functional outcomes in rehab. Medical Expenditure Panel Survey (MEPS) health care expenditures data.

Mental Health

Managed Care and Long-term Services for People with Mental Retardation, Health Policy Report: Managed Care and Mental Health, Parity, Issues in Utilization Management

News

Daily and weekly headline news on the managed care industry. Managed Care Magazine. Managed Care Market News. Horror Stories.

Outcomes

Medical outcomes assessment and research studies. Physical Medicine Utilization Review.

Performance Measures

JCAHO performance measures. ADA/NCQA Diabetes Measures. AHCPR’s CONQUEST. HEDIS. Health Care Quality Improvement.

Practice Management

Online tutorials for healthcare professionals on how to manage managed care. Examples: Guidance on how a physician can avoid being deselected from health plans. Physician profiling and how it can affect a physician's practice. Expediting MCO Payments. Understanding capitation contracts and stop loss. Full text of the fill-in-the-blanks AMA Model Managed Care Medical Services Agreement.

Questionnaires

Overview and explanation of the 36-item short-form (SF-36) that was constructed to survey health status. Statistical results of testing conducted in 1995. Sources for online health status questionnaires.

Report Cards

JCAHO performance measurement ratings for healthcare facilities. USQA Quality Reports. NCQA Accreditation. HEDIS Report Cards. CVO certification. Health plan ranking reports.

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