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As managed care increases its presence in the home care industry, providers need to take a good look at capitation, the reimbursement method that some managed care users. This article explores the issues involved in this new payment method.

Suppliers to the health care industry are changing relationships with their customers by forging partnerships that blur the boundaries between them. Here, representatives from several suppliers discuss what programs and services the market has driven them to offer.

In summary, a dual-group in-hospital Radiology practice by two competing groups is not only feasible, it is indeed a very viable and practical option, capable of producing numerous benefits to patients, practitioners, staffers and facilities. For the model to succeed, there has to be full cooperation on the part of the hospital administrative staff coupled with their firm mandate to facilitate such a progressive practice. Once the process is clearly and carefully explained to the support staff, with well-defined instructions and ground rules, implementation of the model becomes a matter of following a carefully detailed plan of operation. Our experience with this unique alignment produced challenges for all involved. Our Radiologists were tasked to evolve their practice techniques. As well, all our staff and administration were called to redesign, adapt and utilized at St. Elizabeth's Hospital. In our own way, we see our process of assessment, adaptation and implementation of the dual-group model as a schematic for the wellness of Radiology and perhaps even all of Medicine. Our unified focus to achieve a common goal for the good of all, most particularly our patients, has led us through the fog of fear and trepidation into the clarity of reward. Vision becomes reality through individual effort; and all who come through the doors of St. Elizabeth's, now reap its numerable rewards. And most particularly for our healthcare recipients, the one year experience of two competing groups of radiologists working side by side within the Radiology Department of a single hospital, without an exclusive contract, indicates that the model is successful and has no negative impact on patientcare.

Most hospitals now have acquired trust status and managers have started the process of setting contracts with purchasers. In order to assess quality content of contracts for dermatology services, a survey was performed on behalf of the British Association of Dermatologists' (BAD) Audit Subcommittee. A letter was sent to 278 consultant members of the BAD, requesting a copy of their contract: 171 (62%) replies were received. Seventy-four consultants had formal contracts with purchasers, but only 25 (34%) of these had been involved in contract preparation. Several consultants were unsure whether formal contracts existed and many had difficulty in obtaining the documents. The 20 contracts received were highly variable, with a median of 13 (range 0-89) quality clauses per contract. These mostly related to the process of care, particularly waiting times and communication with general practitioners (GPs). Sometimes the structure for delivering care was specified, but only occasionally were outcome measures mentioned. The specified maximum waiting time for a new patient appointment ranged between 4 and 30 weeks (median 13). GPs were to be sent out-patient letters within 3-10 days (median 10) of patient attendance. Following in-patient care a notification was to be sent within 1-3 days (median 2) of discharge and a full summary within 7-21 days (median 12). A requirement for patient satisfaction surveys was included in only six contracts. Greater involvement of consultant dermatologists in setting contracts with purchasers should lead to the inclusion of more consistent and appropriate quality clauses.(ABSTRACT TRUNCATED AT 250 WORDS)

Clinical contract management companies are the new kids on the integration playground--and they're coming on the scene with energy and enthusiasm. But will their strategies for transitioning from the role of supplier to provider work? And what will happen to their relationships with client hospitals?

Sutter Health has announced that it will soon require payers to contract with its entire network. While this strategy may work for Sutter, some have doubts that it will work for systems in other parts of the country.

The authors review the reasons behind the currently evolving restructuring within the healthcare industry and its implications for hospital laboratories. They predict a continuing decline in the volume of inpatient care with a similar effect on the volume of hospital laboratory testing. They also foresee a shift to independent laboratories in the volume of outpatient testing--currently a key revenue source for many hospital laboratories. For those hospitals that redefine their mission, inpatient testing for higher-acuity patients is one role, as is managing point-of-care testing in nontraditional settings.

Direct contracting is an agreement whereby healthcare providers directly contract with employers or health plan purchasing cooperatives to provide healthcare services to their employees or enrollees. While this type of arrangement requires a high degree of integration and cooperation between the delivery and financing of care, the flexibility it offers makes it a necessity in the new world of integrated healthcare financing and delivery systems. This article demonstrates the importance of strong vertical and horizontal links with both other providers and various components of the financing system. It also shows how those organizations with the capacity to finance and assume risk for employers will be most successful and play a major role in the healthcare system of the future.

The growing number of pharmacy benefit management companies (PBMCs) signal the most significant trend in the pharmacy benefit marketplace in many years. The evolution of this industry has made pharmacy benefit management available to smaller health plans and self-insured employers alike. However, the growth of PBMCs has spurred more competition, and profits in the industry are becoming harder to attain. This setting should provide fertile ground for the continuing evolution of entities that offer pharmacy benefit management.

A continuum of managed care options has evolved reflecting differing health care market characteristics. Alternative health plans are increasing, outdistancing the "gold standard" staff model HMOs. A dizzying array of options, however, has led to considerable confusion. Direct contracting has evolved as a way for employers to understand what they are paying for and to managed costs. Increases in managed care, and a degree of financial distress, will encourage the development of integrated networks. National reform is unlikely to convert today's loosely structured system to a fully integrated system overnight, but will stimulate managed care in markets sooner than otherwise expected.

Package pricing of specific services and procedures can be an effective cost-containment and marketing tool for payers and providers. Payers can secure fixed prices at discounted rates, and hospitals and physicians can retain and gain market share in an increasingly competitive health care market. Successful implementation of a package pricing strategy, however, requires a careful assessment of both market and operational factors. This chapter outlines how to identify opportunities for package pricing and how to establish rates and procedures.