Managed care, with its restrictions on patient and provider autonomy, has dominated the delivery of healthcare in the US over the last decade. The latest model of managed care has focused on disease management programs, which outline optimal cost-effective processes for care, built on...

This article exposes and corrects some of the major myths about outsourcing disease management to a specialised expert vendor. Currently, a number of health plan medical directors feel that outsourcing costs more than building internally, will not provide a return on investment, and requires a...

Episodes of care provide a clinically meaningful unit of analysis for measuring both the cost and quality of patient care. Many health plans are currently using episode of care grouping software in cost-focused provider profiling applications. These profiles compare the cost for one provider to...

Objectives: To compare the experience of one managed care organization (MCO) [Anthem Blue Cross and Blue Shield Midwest Region] to the experience of a reference group of 15 other MCOs participating in a study designed to test the usefulness of outcomes management information in developing and...

In this article, the issue of who benefits from managed drug use in assisted living and home care settings is addressed from a clinical perspective. Benefit in clinical terms is always focused on the patient as an individual and not on the system or process of providing managed drug use. Indeed,...

Patients with health insurance do not make the most cost conscious healthcare decisions since they bear only a fraction of the total cost of medical care. Managed care advocates point to financial incentives as a way to reduce wasteful resource use. However, physicians with managed care...

This article describes research-based principles of successful treatment interventions in individuals with co-occurring disorders. These principles are placed in the context of an integrated model of service delivery that utilises a common language or treatment philosophy that makes sense from...

Increasing healthcare expenditures and other economic pressures mandate fundamental reforms of the healthcare system in Germany. The overall goal is restraint of costs while at the same time maintaining a high standard of medical care. Among all options, managed care represents a potential...