Provider capitation readiness and the process of contracting with managed care organizations.

1996 ◽  
pp. 33-43
Keyword(s):  
Managed Care ◽  
Managed Care Organizations

scholarly journals Treating depression in staff-model versus network-model managed care organizations

1999 ◽  
Vol 14 (1) ◽  
pp. 39-48 ◽  
Author(s):  
Lisa S. Meredith ◽  
Lisa V. Rubenstein ◽  
Kathryn Rost ◽  
Daniel E. Ford ◽  
Nancy Gordon ◽  
...  
Keyword(s):  
Managed Care ◽  
Network Model ◽  
Model Versus ◽  
Managed Care Organizations

Cost of atrial fibrillation in United States managed care organizations

2009 ◽  
Vol 26 (9) ◽  
pp. 847-857 ◽  
Author(s):  
Michael H. Kim ◽  
Jay Lin ◽  
Mohamed Hussein ◽  
Charles Kreilick ◽  
David Battleman
Keyword(s):  
United States ◽  
Atrial Fibrillation ◽  
Managed Care ◽  
Managed Care Organizations

Managed Care Organizations' Assessment of Reimbursement for New Technology, Procedures, and Drugs

1999 ◽  
Vol 123 (8) ◽  
pp. 677-679
Author(s):  
Harold Zarkowsky
Keyword(s):  
Managed Care ◽  
New Technology ◽  
Third Party ◽  
Medical Community ◽  
Extensive Literature ◽  
Behavioral Measures ◽  
Randomized Controlled Studies ◽  
Marginal Improvement ◽  
Managed Care Organizations

Abstract Managed care organizations must establish formal processes for the evaluation of new technology, procedures, and drugs to enhance the quality of health care delivered and to support coverage and utilization decision making. Evidence-based research and the results of controlled clinical trials are the preferred sources of outcomes data to support the safety and effectiveness of the technology, procedure, or drug under review. In addition to extensive literature review, the opinion of experts in the field and acceptance by the medical community are considered. Assessments of new technology and drugs are available for purchase from several vendors, and managed care organizations can adopt or modify such evaluations to develop medical coverage policies. The research community can assist third-party payers by conducting studies on practices that might lead to substantial, rather than marginal, improvement in health, pay particular attention to study design when randomized controlled studies are not possible, and include functional and behavioral measures in analysis of outcomes.

The Basics of Managed Care and Its Impact on Private Practice

2017 ◽  
pp. 265-279 ◽  
Author(s):  
Gordon I. Herz
Keyword(s):  
Mental Health ◽  
Managed Care ◽  
Private Practice ◽  
Mental Health Treatment ◽  
Key Factors ◽  
Private Practitioners ◽  
Balance Billing ◽  
Privacy And Confidentiality ◽  
The Impact ◽  
Managed Care Organizations

This chapter describes “managed care” insurance systems and practices that were created to manage healthcare costs. Effects on private mental health practice are identified, such as decreases in reimbursement, documentation requirements, treatment reviews, and other intrusions into clinician–client privacy and decision making. Potential advantages of participation are also identified. Key factors that private practitioners should take into account when deciding whether to participate with managed care organizations include careful contract reviews, likely credentialing requirements, and the impact of reimbursement on a practice. Potential solutions to common challenges are provided, such as limits on balance billing and waiver of co-payments. Ethical concerns specific to providing mental health treatment in the managed care context are discussed, such as limits on privacy and confidentiality. Potential implications of the ongoing seismic changes in the healthcare system for the future of managed care and private practitioners are explored.

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