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The emergence of managed care has significantly influenced the financing and delivery of mental health and health care services. Having survived a lon...
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Background
"Managed care" refers to that type of health care system under which medical care and treatment is managed by the entity paying t...
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MHPA Finds Serious Flaws in Study Methodology, Disputes Findings
WASHINGTON, June 30, 2011 /PRNewswire-USNewswire/ -- The June 2011 Commonwealth Fund Issue Brief, "Assessing the Financial Health of Medicaid Managed Care Plans and the Quality of Patient Care They Provide," used limited data to draw inappropriate conclusions regarding the Medicaid health plan industry asserts Medicaid Health Plans of America (MHPA), the trade group representing the industry.
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04-3300(L), 04-3464(CON), 04-3545 (CON), 04-3871(CON)
Gruer v. Merck-Medco Managed Care, LLC
UNITED ST...
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While the state of New Hampshire decides whether to approve its largest vendor contract ever--$2.3 billion to hire three comp...
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The purpose of this study was to identify personal, economic, and health care system barriers to mammography in a managed care population. Participants were Black and White female residents of Middle Tennessee, aged 40 years and older, who were members of a Medicaid-funded managed care organization and, according to claims data, were not current with mammography screening at least one year prior to study initiation. Twenty-one barriers were grouped into three categories - personal, economic, and health care system barriers. Trained interviewers recorded participant self-reported responses to barrier statements from 173 women (46% Black) through telephone or personal visits. The correlations of reported barriers to annual checkup, clinical breast exam, and mammogram screening were examin...
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Within the U.S. healthcare system, managed care companies finance and manage healthcare delivery and associated costs by structuring insurance healthcare benefits so that services are provided through networks of providers with negotiated rate structures. According to the Centers for Medicare & Medicaid Services (CMS), the selling, general, and administrative (SG&A) costs in publicly traded managed care companies from 1999 to 2002 comprised 15.9% to 17.0% of premium revenues. Because profit margins are typically small in managed care companies, it is important to seek reductions in SG&A costs as a percentage of premium revenues by managing their cost drivers, such as technology and employee turnover, to increase profit margins. This is a more effective technique than seeking...
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With this in mind, I now return to the concluded debate on mental health parity and resurrect a critical issue that undoubtedly will be raised again in healthcare reform discussions - managed care's role in a transformed system. [...] the parity law brings new attention to managed care, enabling health plans that provide mental health and substance abuse coverage to make "medical necessity determinations" for both in-network and out-of-network care.
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Some lawmakers continue to question the state's plans to make sweeping changes to its Medicaid program.
On Tuesday, a legislative oversight committee heard from the three managed-care companies contracting with the state Department of Health and Human Resources to administer Medicaid benefits for West Virginians.