Contents:

CHAPTER 1: GENERAL MANAGED CARE TRENDS . Recapping Topics that Pushed Managed Cares Hot Buttons Census Bureau Reports Decline in the Uninsured AARP Report: Dissimilarities Among States Staff Model HMOs Get Lowest Rating for Primary Care PPOs: Enrollment Up, Popularity Increasing Findings Show HMOs Lost 500,000 Enrollees Between January and July 1999 No Discrimination Found in HMO/Non-HMO Admit Rate Americans Dont Understand Managed Care Managed Care Professionals Salaries Are Up — Way Up CHAPTER 2: MERGERS AND ACQUISITIONS: AN INDUSTRY UNDER CONSOLIDATION . PMGs Lead in 3Q 2000 M&As PPMs Are Reverting Back to Original Owners Managed Care M&As Take Steep Nose Dive MCO Mergers Facing Strong Opposition Consolidation Continues for Managed Care Consolidation Helping HMOs Return to Profitability CHAPTER 3: EYE ON MANAGED CARE FINANCIAL TRENDS . As Predicted: Healthcare Costs Are Rising Healthcare Cost Increases Were Expected to Double in 1999 — Americans Concerned With the Effects Provider Reluctance To Negotiate Causes Medical Inflation Rate To Reach Double Digits in 1999 Unexpected Surge in Managed Care Enrollment Held National Cost Increase to 0.2 Percent in 1997 HMO Profits Are Improving MCOs Retain a Larger Portion of Overall Revenues Quarterly Analysis Shows HMOs Generally Performed Better in 1998 than in 1997 Lending Institutions Say "Nay" to Healthcare Trade S&P Outlook: Industrys Secure Fourth Quarter 1999 Prices Up Year-to-Year Prices Decline CHAPTER 4: COST CONTAINMENT: MAKING THE MOST OF HEALTHCARE DOLLARS . Blending PPO Flexibility With HMO Cost Controls Proves Beneficial Study Identifies Average MCO Expense Ratios Poll: If MCOs Ditch Cap, Would They Lose Control? U.S. Hospitals Are Broke, MCOs Tactics to Blame Ensure Profitability by Re-Evaluating Your Management of Medicare Revenue Improve Profitability by Managing Injury and Work-Related Claims Better Care for Depressed Saves Money Healthcare Companies Partner to Battle Fraud CHAPTER 5: THE MANAGED CARE BACKLASH: AN INDUSTRY UNDER FIRE . Government-Appointed Task Force Suggests Improvements New York Plans Work To Improve Managed Care Image Much Attention Given To Few Managed Care Complaints Finding the Villain in the Health Insurance Blame Game Accusations Point to MCOs ‘Retrospective Review Tactics HMO Stereotypes Influence Consumer Ratings of Their Healthcare "Feelin Good" Ad Campaign Focuses on Customer Service and Positive Attitudes Lawsuits Raise Issues With Health Plans Business Practices Forms No More! Why More MCO Physicians Need To Join Medical Societies CHAPTER 6: MEMBER RETENTION: STRATEGIES TO MAINTAIN SUCCESS . How To Keep Your Customers Happy Three Reasons Cited for Managed Medicare Disenrollment How To Increase Retention, Loyalty Providing Requested Medications: One Way To Maintain Satisfaction Increase Satisfaction By Letting Consumers Have Their Say AAPPO Launches Campaign To Explain Advantages of PPOs CHAPTER 7: BEST PRACTICES: SERVING THE MANAGED CARE CONSUMER . Study Examines HMO Customer Satisfaction Levels Survey Shows Consumers Perceptions of Healthcare System Majority of HMO Members Still Reporting Overall Satisfaction Survey Compares Trends in Satisfaction and Identifies Top HMOs Anthem BCBS Targets Womens Health Issues CIGNA HealthCare Improves Care for Women: Program To Cover Cancer Screenings Blues Board To Draw Attention to GA Womens HealthIssues Second Humana Service Promise Provides Round-the-Clock Assistance Aetna Targets College Students Searching for Healthcare Enrollees Are Served Better by Not-For-Profits The Effectiveness of a Marriage Between an HMO and Wellness Program MCOs Reaping the Benefits of Health and Wellness Programs Blue Shield of California Offers Free Online Healthcare Services Health Plan Reaches Out to Community Through Educational Initiative CHAPTER 8: MAKING MANAGED CARE WORK . One Plans Demise Doesnt Equal Another InsurersRise Future Challenges for Managed Care Claims Processing Understand Why, How and With Whom to Outsource Your Business Functions Taking Control of Managed Care Risks and Liabilities CNA Offers Strategic Advice To Deal With Liability Issues Ensure Consistency When Defining Medical Necessity Caring for Healthcares Majority — Addressing Womens Needs PacifiCare Restructures, Three Divisions Created Managed Care Directory Provides Market Research, Benchmark Analysis CHAPTER 9: EXAMINING MANAGED CARE BENEFITS . New Study Shows Severe Decline in Behavioral Healthcare Benefits Changing Times: MCOs Offer Mental Health Benefits Most Often Number of MCOs Offering Psychiatric Benefits Doubles in Pacific Region Depression Treatment Leaves Something To Be Desired Chiropractic Benefits More Likely in Rural MCOs Vision Benefits Less Common Among MCOs in Densely Populated Regions Dental Benefits Move to Managed Care One in Five MCOs Covered Workers Comp Number of MCOs Covering Home Health Grows by 60 Percent CHAPTER 10: COMPLEMENTARY AND ALTERNATIVE MEDICINE: NEW TREATMENT METHODS IN MANAGED CARE . Complementary and Alternative Medicine: Consumer and Physician Attitudes Examined HMOs Moving To Integrate Alternative Care Consider a Supplemental Rider When Offering CAM Benefits to Enrollees Supplemental Rider Most Popular for CAM A Working CAM Model: An Administrative Perspective How To Integrate CAM Into Your Program: An Administrative Perspective MCOs Can Build Chiropractic Networks Faster CHAPTER 11: DISEASE MANAGEMENT: IMPROVING LIVES, REDUCING COSTS . Association Helps Clarify DM Cost-Effective/Clinically Oriented Programs Disease Management a Plus, But More Can Be Done Disease Management Company Expands Managed Care Services NYLCare Finds Success with Disease Management Program Programs Successfully Target Congestive Heart Failure Innovative Program Attacks Asthma and Other Respiratory Diseases Smoking Cessation Designed for All Groups and Ages Pharmacy-Level DM Program Nets 25.4 Percent In Savings for CIGNA Conference Highlights the Questionables of Online Disease Management CHAPTER 12: MANAGED CARE PHARMACEUTICAL ISSUES . United Healthcare Revamps Pharmacy Benefit Rising Pharmaceutical Costs: Examining Causes, Effects and Changes to the System Despite Changes/Restrictions, Enrollees Rate Pharmacy Benefits Highly Plans To Benefit From Pharmacy Web Sites American Pharmacy To Aid Japanese Counterparts CHAPTER 13: THE EMPLOYER SIDE TO MANAGED CARE . Taking a Look at Healthcare: The Employers Perspective Employers Improving Healthcare Through Value-Based Purchasing Movement to Value-Based Purchasing Hindered by Six Obstacles Rise in Healthcare Costs Puts Direct Contracting Back on the Table Sifting Through the Assortments in Employer-Sponsored Health Insurance RU-486: Covering it Pushes Ethics and Politics Aside CHAPTER 14: LEGISLATION AND REGULATION . HIPAA Will Have Major Impact on Healthcare Industry HIPAA Transaction Regs Finalized Plans, Providers Will Be Scouting Vendors Can You Hear the Clock Ticking? 2001 and HIPAA: A Health Odyssey How To Prepare for HIPAA Regulatory Challenges Facing HIT Companies The Dynamic Dozen: Some Top Resources for HIPAA Information Professionals Doubt Legislators Ability To Fully Understand the Healthcare System HCFA Addresses National Coverage Decisions MCOs Need To Prepare for Risk-Based Capital Requirements Wide Variations in PPO Oversight, A Comparison of States Reveals Physicians and Other Providers Could "Unionize" Under Bill Bill Would Require Permission To Record Phone Calls Bill To Protect Managed Care Customers CHAPTER 15: MEDICARE AND MEDICAID MANAGED CARE . The Implications of Medicare Reform on the Healthcare Market Medicare+Choice Adds More Choices for Enrollees and Fuels Competition Among Health Plans Face-To-Face Q&A Meetings for Medicare Enrollees Manage Care and Reduce Utilization To Succeed in Medicare Ensuring Success in Medicare Risk Risk Adjustment Gives MCOs Higher Medicare Premiums Beneficiaries With Cancer Get Better Care from HMOs CIGNA Not Alone in Medicare Withdrawals Managed Medicare Member Retention Affects More Than Balance Sheets OIG To Take Another Look at Medicare Managed Care Marketing Materials Medicaid Misperceptions: What Can Be Done To Change Them? CHAPTER 16: MCO-PROVIDER RELATIONS . MCOs Beef Up Contracting To Meet Demand for More Comprehensive Network MCOs Should Improve PCP Contracts Coastal Regions Home to Largest IPA-Model HMOs Regional Analysis Shows Prevalence of MCO-IDS Affiliations Antitrust Controversy Pits MCOs Against Docs (Again) Court Ruling Opens the Door for Physicians Contract Disputes Data Shows Managed Care Prevalence in Physician Organizations Trends in HMO-Physician Reimbursement Fewer Referrals From PCPs Could Be Taking Its Toll MCOs Should Have Helped Row the Boat, Before They Jumped Ship CHAPTER 17: PHYSICIAN-PATIENT RELATIONS . Improve Healthcare Services: Break Physician-Patient Communication Barriers Physicians Working To Improve Patient Relationships Managed Care Physicians Must Address the Age of Consumerism Study Champions Primary Care Physicians Role in Specialist Referrals CHAPTER 18: ACCREDITATION: MEASURING THE QUALITY OF MANAGED CARE . Keeping Up With Accreditation Accreditation Organizations Form New Group To Combine Efforts Reporting HEDIS — Health Plans Face Information System Problems NCQAs HEDIS 2000 Targets Care for Chronic Diseases URAC Accreditation Highest for PPOs in Pacific Region URAC To Develop Flexible Ranking System NCQA To Refine Accreditation Program Aim Is Patient Safety CHAPTER 19: QUALITY ASSURANCE: ENSURING THE BEST POSSIBLE CARE . AHRQ Targets Health Outcomes and Quality Consumers Assessments of Medicare Plans Online Healthcare Execs Split Over Having Only One Quality Oversight Body Study Shows Link Between Cost and Quality PacifiCares Report Drives Quality Among Physicians NY HMO Plans Earn Passing Report Card Grades URAC Defines Three Categories of PPOs Managed Care Outperforms FFS, Study Shows CHAPTER 20: TECHNOLOGY TAKING A STRONGER ROLE IN MANAGED CARE . Survey Examines Medical Management and Data Analysis Opinions Healthcare Organizations Need To Plan for Disaster Recovery Address IT Issues Before Entering Any Healthcare Merger Kaiser Awarded for Efforts in Computerized Patient Records AAHP Approves Initiative To Guide Health Plans E-health Activities URAC Appoints Members of Health Web Site Advisory Committee How To Ensure Your Web Site Is Not a Liability Aetna U.S. Healthcare Moves Toward Paperless Claims Processing and Referrals Technology Cited As Top Method To Improve UR Electronic Medical Records — Should They Be an Industry Standard? HealthLink America Measures Patient Satisfaction Community Profiling Aids in Strategic Marketing Online Marketplace Created For MCO Executives New Jersey Healthcare Members To Benefit From Internet Service CHAPTER 21: LOOKING AHEAD IN MANAGED CARE . PPOs, HIPAA and Online DM Are Among the Top Trends for 2001 Top Trends for Managed Care in 2000 Healthcare Expenditures Rising: 10 Year Prediction Calls for Twice as Much Spending How To Integrate Successfully for the 21st Century Looking Ahead: Future Trends in Managed Care Rising Premiums Are Not the Only Concern on the Healthcare Horizon Experts Give Some Healthy Advice to the Managed Care Industry A Call To Arms Against Medical Errors Consumers Willing To Pay Fee and Switch Health Plans for Online Health Services PPOs Are Increasing in Popularity Study Shows Effects of Managed Care Growth on the Hospital Community Help Wanted: New-Aged Medical Director Leadership CHAPTER 22: MARKET NEWS . Market Partnerships Contracts Awarded Acqusitions Consolidations New Managed Care Products New Market Expansions Network Creations Network Developments Certifications Strategic Plans Deals Undone MIS