HMOs must submit Medicare HEDIS
Article Abstract:
Health maintenance organizations (HMOs) are required to submit the latest version of the Health Plan Employer Data and Information Set (HEDIS 3.0) for all Medicare members. HEDIS allows purchasers to compare the cost of HMOs with the benefits received. HEDIS is limited by its dependence on aggregate data, contains less information than the data provided by the Health Care Financing Administration, and does not inform the consumer about the quality of care provided by individual members in an HMO network.
Publication Name: Nursing Management
Subject: Health
ISSN: 0744-6314
Year: 1997
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Network formation made easier
Article Abstract:
Changes in federal guidelines concerning physician and multiprovider networks' compliance with antitrust statutes have made it easier for physicians and other providers to form joint ventures and compete with managed health care plans. The changes and improved competition will help reduce inflating medical costs. The revised guidelines also offer broad implications for managed care providers' growing role in Medicare.
Publication Name: Nursing Management
Subject: Health
ISSN: 0744-6314
Year: 1996
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