Managed Care Business Briefs
Managed Care Business Briefs
• Average per-member-per-month capitation rates increased for most specialties in 1996 compared to the previous year, according to a national survey of 525 managed care plans conducted by Rockford, IL-based Warren Surveys, a subsidiary of DeMarco & Associates. Bill DeMarco, CMC, MA, president of DeMarco & Associates, says the increase is likely a result of HMOs’ overall willingness to pay providers more while also requiring providers to take on additional services. See charts inserted in this issue for details of these rates by specialty.• Prudential Insurance Co. of America has named Steve Shulman, a former executive of Avon, CT-based Value Health, as president and CEO of Prudential’s managed care unit, Prudential HealthCare. If your practice contracts with Prudential, look for Physician’s Managed Care Report’s story in our June issue that will discuss how the new leadership will affect your practice.
The managed care unit of the mutually owned company began losing money several years ago, partly because of pricing pressures in the managed care industry. Its 1996 losses topped $300 million on a statutory accounting basis, which is a more conservative form of bookkeeping than most publicly traded companies use. Prudential’s previous two top health care executives resigned in 1996 in a move analysts said reflected the parent company’s growing dissatisfaction with the health care unit’s financial losses.
• Aetna U.S. Healthcare and New York Medical College have started a program to promote and financially support the continued professional development of managed care physicians. Under the program, primary care physicians practicing in a managed care environment will serve as mentors to medical students at the College. These physicians will provide medical students with office-based training in the principles of primary care medicine, patient education, preventive care, and teamwork. Aetna will compensate the physicians for these services.
• Humana Inc. announced in April that it has eliminated its physician referral process for emergency room treatment and access to some specialty physicians. The company said it expects a series of initiatives, scheduled to be implemented during the first half of 1997, will eliminate more than one-quarter of all referrals now being received by the carrier. Humana currently contracts with more than 40,000 physicians nationwide.
• Pennsylvania Physicians Care has been granted a license to market its preferred provider organization product in 16 Pennsylvania counties. The company plans to offer a non-gatekeeper PPO product through employers in south-central Pennsylvania, through the Lehigh Valley, and into northeastern Pennsylvania.
Following are names and telephone numbers of sources quoted in this issue:
• Browne-McHardy Clinic, Metairie, LA; Robert Goldstein, chief operating officer. Telephone: (504) 889-5218.
• Arizona Medical Association, Phoenix; Tom Marks, vice president of operations and membership. Telephone: (602) 246-8901.
• Towers Perrin, Charlotte, NC; Dave Garbrick, principal and health care practice leader. Telephone: (704) 348-3300.
• The Scheye Group Ltd., Chicago; Elaine Scheye, president. Telephone: (773) 989-7483.
• Warren Surveys, Rockford, IL. Telephone: (815) 877-8781.
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