What's next for managed care? Panel discussion.

Change continues to be health care's only constant in the United States. As enrollment in managed care organizations skyrockets, the glare of public scrutiny intensifies. Success is no longer as simple as undercutting traditional fee-for-service providers; MCOs have to become more responsive to consumer needs as they compete with one another. Whether substantial set of values or mere buzzword, quality is the lingua franca of the MCO arena. Although MCO executives attribute the concept's ubiquity to many factors, the common denominator is staying competitive in a high-growth industry. Along with the elimination of the gatekeeper, a major trend to watch for is the rise of industry oversight provided by standardized practice guidelines. MCO executives recognized that implementing such measures will streamline operations and make MCOs more user-friendly.

Improving the quality of care and reducing health care costs through a point-of-service health care information system.

Health care information systems will become critical to the success of health care providers. These systems must make the process of health care delivery more effective and more efficient, assisting the provider in improving the quality of care while maximizing cost reduction through more appropriate care and reduction in administrative costs. The system must be able to capture accurate encounter data for outcomes analyses and capable of use by multiple health plans for their unique policies or programs such as disease management. The most effective means of achieving all of the above will be to re-empower the physicians through software placed in a mobile computing environment with full integration among all participants.

Implications of disease management in the future of managed care.

Disease management holds the promise of profound improvement in the care presently delivered to sufferers of specific diseases and provides the potential for a marked reduction in both short- and long-term health care costs. It has created an excitement that has formed new partnerships, caused managed care organizations to alter their focus, and encouraged the pharmaceutical industry to spend its wealth of resources on the total well-being of the patient. The authors address the somewhat ambiguous definition of disease management and examine the essential elements required to successfully implement programs of this nature.

Is success spelled g-a-t-e-k-e-e-p-e-r?

The President's health care reform proposal will require a point-of-service (POS) mandate for any managed care organization seeking to serve as an accountable health plan. However, POS plans have not been proven to contain costs, and may in fact, contribute to continuing health care cost escalation. A study was performed by a managed care organization to evaluate whether the use of gatekeepers in POS plans is associated with lower health plan costs.

Provider selection standards as a quality indicator.

There are many lessons that PPOs and their clients have learned during the past decade. Data are essential. Few claims administrators have invested the capital or resources to capture other than minimal data--many capturing only the elements required to produce a reimbursement check. The more extensive the data collection, the greater the potential for improving quality. The best way to assure the delivery of high quality health care is to implement a rigorous selection process, preferably prior to granting membership. In an ideal world, selection can lead to the elimination of many aspects of managed care so that the focus can be placed on physicians whose practice style yields lower quality and higher costs. The ability to implement CQI in a PPO is limited only by the ingenuity of the reviewer and the data. Most importantly, the past decade has proven the basic tenet of managed care--quality health care is cost-effective health care.

Two estrogen receptors in reproductive tissue.

PIP: 2 estrogen binding proteins of distinct high and low affinity, previously observed in calf and rat uteri, were observed in both chicken oviductal tissue and human uterine tissue. Charcoal binding and hydroxylapatite assays were performed and data were analyzed by Scatchard plot analysis. Diethylstilbestrol was used for stimulation in assay. The 2 cytoplasmic components were specific for estrogens and had equilibrium dissociation constants of 1010 and 109M. 2 binding components of similar affinities were also detected in nuclei isolated from oviducts and uteri which had been exposed to the diethylstilbestrol. Because the 2 components have now been established in widely divergent species, the presence of 2 putative estrogen receptors should be considered commonplace and that information should be used when considering steroid hormone action on the molecular level.^ieng