...Peter D. Jacobson; Matthew L. Kanna This article provides an initial look at how managed care organizations(MCOs) might incorporate cost-effectiveness analysis (CEA) into their decision-making process and how the courts might respond. Because so few medical liability cases directly involve CEA, we...

... reduce patient access to providers, along with provider access to paying patients, so many providers have lobbied for AWP-FOC laws. In opposition are managed care organizations (MCOs), which want full freedom to contract selectively to control prices and utilization. This article comprehensively...

... because of managed care. Yet, real suf- fering has occurred, and some of it is attributable to bad decisions made by officials of managed care organizations (MCOs). But errors and insensitivity to patients were part of the indemnity landscape as well, and in spite of the publicity, there is no evidence...

... (e.g., mandatory external appeals, liability rights, and making managed care organization [MCO] medical directors subject to the dis- Journal of Health Politics, Policy and Law, Vol. 24, No. 5, October 1999. Copyright © 1999 by Duke University Press. 1062 Journal of Health Politics, Policy and...

...Figure A1 Medicaid Commercial MCO Penetration and Medicaid Reporting Rates Figure A1. Medicaid Commercial MCO Penetration and Medicaid Reporting Rates ...

... over the decades from these multiple perspectives, limiting the narrative to public officials, managed care organizations (MCOs), selected providers, and enrollee advocates. It is an innovative approach that yields a rich amount of information concerning the various groups. Bennett argues that...

.... Managed care organizations (MCOs) and the private sector, so the story goes, are not perfect, but the alternative—having legislatures man- age health resources and bureaucracies make health care decisions—is Funding provided by a Robert Wood Johnson Investigator award. Helpful comments were pro...

... capitated managed care organizations (MCOs) and outlines several implementation challenges the CCO model faces. In 2009 House Bill 2009 established the Oregon Health Authority (OHA) as an independent agency. It also established the Patient-Centered Primary Care Home (PCPCH) program, to promote...

... unrelated managed care organization (MCO) that participates in Medicaid. ▪  Change in provider . This would occur when a person must change provider because his or her former provider is not in-network in the new program or carrier. This form of disruption, we should note, could occur even if the QHP and...

... 1988, 1993; Congressional Research Ser- vice 1993; Lewin–VHI 1995; Rowland et al. 1995). Under risk-based capitation programs, states contract with managed care organizations (MCOs)—which can include private health maintenance organizations (HMOs) or prepaid health plans (PHPs) such as federally...

... reform adopted in Connecticut, and many other states, was primarily a contracting regime change where the state switched from paying Medicaid providers directly for services rendered to contracting with managed care organizations (MCOs). In Connecticut’s case, the state actively recruited...

... spectrum of countries. Background Managed care organizations (MCOs) were developed in the United States several decades ago largely as a response to escalating health care costs. Like “traditional” private health insurers of the 1960s and 1970s, most Weiner et al.  ■  Global Context of...

... states contracted with managed care organizations (MCOs) to provide Medicaid services, and projections show that 76 percent of the national Medicaid population will be enrolled in some form of managed care by 2016 (Paradise 2014 ; Pearson 2014 ). Although Iowa has gradually expanded the role of MCOs in...

...- ically appropriate with little need to explain or justify their decisions. Over the past quarter century, managed care organizations (MCOs) have shifted power away from physicians to payers. MCOs required, in one way or another, that doctors and medical...

...., health maintenance organizations [HMOs] or managed care organizations [MCOs These entities take responsibility for both financ- ing and delivery of care; to do so at competitive prices, they must bring Journal of Health Politics, Policy and Law, Vol. 29, No. 6, December 2004. Copyright © 2004 by...

... to include prescription drugs, lower OOP costs, and a broader network, the policy preferences of seniors began to change. With this policy change came a dramatic political change. It was not, as we have seen, just beneficiaries that became a protective constituency behind MA; so did the MCOs, whose...

... negotiations with MCOs ran before the application was submitted, how quickly these applications could be prepared and approved internally once green-lighted, and how quickly CMS could review and approve the applications. Reviewing state plan approval documents, we found that only one-third of states applying...

... managed care organizations (MCOs). s A particular provider—that is, prospective rate-setting systems for hospitals and ambulatory care organizations (such as in Maryland), Certificate of Need (CON) programs for hospitals and nursing homes (such as in many states), or practice guidelines...