HEDIS is bigger and better
Article Abstract:
HEDIS, or Health Plan Employer Data and Information Set, is used to compare the quality of health maintenance organizations and to evaluate how well they are doing in providing various medical services. Regulatory agencies will use them to support oversight activities. Health plans will rely on them to evaluate performance and to pinpoint areas needing improvement. Eight domains divide HEDIS 3.0 and they have names like effectiveness of care, cost of care and health plan stability. HEDIS is complex and its complexity is growing.
Publication Name: Nursing Management
Subject: Health
ISSN: 0744-6314
Year: 1997
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Federal rules expanded for physician incentive plans
Article Abstract:
Managed care organizations (MCOs) must submit information about their physician incentive plans to the Health Care Financing Administration. Incentive plans may influence the referral services Medicare and Medicaid members of an MCO receive. The new regulations define the physician's risk as substantial if more than 25% of the physician's income depends on referrals staying within cost limits. Incentive plans encourage limiting unnecessary services and can limit medically necessary care.
Publication Name: Nursing Management
Subject: Health
ISSN: 0744-6314
Year: 1996
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Latest Medicaid managed care plans
Article Abstract:
Nurse managers face increasingly complicated state regulation of Medicaid managed care plans. Interaction with the Medicare and Supplemental Security Income systems adds to these complications. Managed care networks will have to expand their capacities to accomodate new populations as state reforms proceed. Integration may be needed for delivery and financing, both for long term and acute care services.
Publication Name: Nursing Management
Subject: Health
ISSN: 0744-6314
Year: 1997
User Contributions:
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