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Managed Care

 

 

April 2003

The big packages of the 1990s are long gone. Mergers mean stiffer competition for fewer positions.
Ed Silverman
Can MCOs cope with conflicting demands for cost shifting, comprehensive care, and new services for an extremely influential demographic?
John Carroll
HMOs are not rushing to follow the lead of the largest not-for-profit health plan because they fail to see how this makes them more competitive.
Maureen Glabman
A federal court of appeals says that some benefit denials are really medical treatment decisions. Medical directors, take heed.
Jack A. Rovner ; Douglass G. Hewitt
Federal law restricts the leverage given to negotiators for physician associations. Plans should know what is, and what is not, legal.
John W. Jones
The impact of this debilitating disease has been largely underestimated, yet new biologic agents offer significant clinical benefit to those afflicted.
David M. Pariser, MD



Departments
Editor's Memo
John A. Marcille
Legislation & Regulation
Several attorneys general have joined the U.S. Justice Department in questioning some AWP billing and reimbursement practices in Medicaid and Medicare.
John Carroll
Ethics
If a doc is compensated when he schedules a patient visit to convey the routine results of a lipid test, but not when he phones the patient, which behavior will he choose?
Michael S. Victoroff, MD
The Formulary Files
Tomorrow’s Medicine
It is expected that by 2004, 197 biologic medications will be available. Just what kind of an impact will they have on managed care?
Thomas Morrow, MD