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References in periodicals archive ?
A state would contract with a managed care entity and pay it a per-patient, per-month rate.
A Five Star rating over a Three Star rating from CMS for a managed care entity will yield a Quality Based Payment of an additional $15 to $16 per member per month above the base.
They moved past blaming one another for the system failures and came to the table to create a new focus on "providing the right services to keep children from cycling through hospitals and residential care settings and to keep them stable in their home communities," said Marsha McMann, director of Foster Care for Cenpatico/Integrated Mental Health Services, the behavioral health managed care entity for children in foster care and a key partner in the system.
Patrick O'Meara, the former chair of the Department of Orthopedic Surgery at Palomar Medica Center (Palomar), sued Palomar and related entities, and various individuals on Palomar's medical peer review' committees, alleging that the defendants improperly retaliated against him because he expressed dissatisfaction with a managed care entity's involvement in medical decisions.
Third-party payer: HMO or other managed care entity that administers a health care plan and arranges for payment of medical services.
In public sector managed care, attention must be paid to the contract between the public sector payer and the managed care entity, said Dr.
However, in most states these providers are not subject to licensure as a managed care entity or insurer as long as their upstream partners are licensed.
Third-party payor lobbyists argue that managed care entities create payment systems and serve as a delivery mechanism in today's health care landscape.(246) They maintain that one would be hard-pressed to argue the benefits that have been brought to the table because of the introduction of the managed care entity into our health care system.(247) For example, managed care entities have assisted our nation in stalling the ever-increasing costs of health care premiums.
It should come as no surprise that managed care entities are now facing claims of bad faith for their decisions concerning treatment and that those claims are also being based on the conflict between cost containment goals of the managed care entity on the one hand and the right to proper patient care on the other.
He recommends that employers compare a list of their employees' primary physicians with the list of providers a managed care entity is offering and see if there is enough of a match.
States also identified areas to avoid in health care reform (such as splitting acute and long-term care responsibilities between the managed care entity and the public sector) and areas to include (such as providing a single system for children with serious and mild disorders).
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