...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...

... 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 ...

... 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 these players, all of which had decent intentions and...

... Other legislation, such as bans on “gag rules” that prevent physicians from communicating with patients, addressed problems that had no basis in fact (Ignani 1998). Summed up, the backlash was interest group politics at its worst and produced bad policy. Managed care organizations (MCOs) and...

... 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 adoption of PCPCHs for OHP members...

... correlated with medical needs. Disruption in care as a result of churn can take four different forms: ▪  Change in carrier . This would occur when a person moves between a QHP that participates in the marketplace and an unrelated managed care organization (MCO) that participates in Medicaid. ▪  Change...

... 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...

... 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 commercial MCOs to contract with the state to provide services to Medicaid recipients...

... 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...

... ; Iowa Department of Human Services 2015d ). While the comprehensive nature of Iowa's Medicaid Modernization is unique among states, the program is generally consistent with national trends: as of 2014, thirty-nine states contracted with managed care organizations (MCOs) to provide Medicaid services...

... 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 institutions change their conduct. Along with new...

... 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 Duke University Press. 1046 Journal of Health Politics, Policy...

... sustained double-digit annual growth rates, Democrats controlled the White House and both houses of Congress. When the Balanced Budget Act of 1997 (BBA) was enacted, legislation that was expected to significantly increase managed care organization (MCO) participation and beneficiary enrollment, it was...

... or vaccination services) and how the elevated fees would be paid for, most states still grappled with two key questions: First, which providers would be eligible for the fee bump? Second, what would it mean to pay increased fees for primary care services through the managed care organizations (MCOs...

...) fee structure for physicians under the Medicare program, second opinion requirements for surgery under private insurance, or capi- tation payment methods in health maintenance organizations (HMOs) and managed care organizations (MCOs). s A particular provider—that is, prospective...