GLG News by Managed Care Experts

  This article is important because it raises the issue of how much, if any, health care cost should be placed on the back of the consumer. It is a relatively superficial look at a broader issue. The answer to the question: what is the health outcome impact on patients who have to pay increasing...

1. Hospitals will be better able to work with their medical staffs on "putting teeth" into infection control and other important committees- not unlike the impetus to manage inpatient days that resulted from DRG payment in the 80's 2. After all the cacophony of complaints about how to define nosocomial...

(AOC, TRV, CB, MMC, WSH) Marsh paid the highest fines for a NY settlement, and other states may impose fines.  Same states may allow undisclosed fees in certain lines of insurance. Travelers is actively trying to restart a defined contingency fee and has apparantly stated guidelines per NU....

The current RBRVS pre-payment system to hospitals currently rewards hospitals for those patients who suffer a hospital induced infection, injury, or other illness that elevates their acuity and ultimately payment from Medicare.  Only a payment for services system that pays for excellence and a...

Retail clinics are health care centers of limited low risk services staffed most commonly by masters in primary care level nationally certificated Nurse Practioners who have provided primary care to millions of Americans for 40 years without issues of Quality by all evidence based studies. This...

Members on State Drug/Formulary Advisory Committees have oversight of hundreds of millions of dollars in expenditures.  It is now coming to light that some providers on these committees have been reimbursed large sums by pharmaceutical manufacturers. This potential conflict of interest will receive...

1. Money is the most powerful lever that drives provider behavior 2. To effect the changes outlined in the Quality Chasm report of Institute of Medicine, relying on provider altruism has been a non-starter 3. Not paying for bad performance should not be cast as a conspiracy to reduce physician...

Managed Medicaid is not a new concept. Over the last two decades, many states have implemented Managed Medicaid programs under the Centers for Medicare and Medicaid Services (CMS) 1115b Waiver program. The waiver program allowed states to implement Managed Medicaid programs as demonstration projects. Medicaid...

1)  Payment reductions for medical errors will not change provider behavior. 2)  Reduced payments to providers could accelerate medical errors.    

Managed care can have a positive impact in the Medicaid market if done correctly.  There needs to be strong oversight in the development process and once operational to ensure that services are delivered. Other States have been doing this for years with varying degrees of success. There are some...