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ABSTRACT Background: Catheter-associated urinary tract infections (CAUTIs) are preventable adverse outcomes that cause increased morbidity, mortality, and financial burdens to hospitals. These are particularly prevalent in intensive care units (ICUs). [...]

With competition for enrollees reaching a fever pitch among health plans, calls are coming from many quarters for a reinvention of healthcare to focus on patients. That is producing a [...]

The Seattle, WA, healthcare market gives patients choices. For example, patients in the area have been among the first to have widespread access to alternative treatments. However, the openness of the healthcare market has hurt the profits of many Seattle healthcare providers. Most of the patients served in the Seattle market have PPO or point-of-service healthcare plans., Perhaps because Seattle's weather is uniformly dreary, residents expect a lot of choice in other areas, including coffees, microbrews and seafood. They are no less selective when it comes to [...]

US managed-care expertise is in demand worldwide as governments strive to trim wasteful healthcare delivery systems and control costs. The globalization of managed care has also been boosted by the willingness of a rapidly growing middle class to pay premium rates for quality medical treatment. US companies that are finding fertile overseas markets include United HealthCare Corp in South Africa and Cigna HealthCare in Brazil., Like it or not, managed care is taking root across the globe. As more and more governments move to control costs and privatize wasteful healthcare delivery systems, and as a [...]

The 1997 up and comers in the healthcare industry include Bobby Jindal, Lawrence Abramson, Corwin N. Harper and Sandra R. Hernandez. Hernandez is the director and CEO of the San Francisco Foundation, while Harper serves as the medical group administrator of the Permanente Medical Group. Abramson serves as senior VP of business development at PeaceHealth, while Jindal is the secretary of the Louisiana Dept of Health and Hospitals. The one trait all the up and comers share is leadership ability., Leadership defies convention. It is both singular and diverse, subtle and bold. Leadership moves others, transcends the obvious and stretches the boundaries of what we can achieve. Leadership is always [...]

Kaiser Foundation Health Plan Inc., the nation's first and largest health maintenance organization, is suffering from poor public relations that have tarnished its former image of being an exemplary healthcare provider. Kaiser is a massive non-profit, integrated healthcare delivery system, and evidence seems to reveal that it is a quality leader in many healthcare areas, and that its quality is improving., Kaiser is the best of HMOs, Kaiser is the worst of HMOs. To its supporters, Kaiser Permanente is what an HMO should be: an integrated and cost-effective healthcare delivery system [...]

Los Angeles County, California created a health maintenance organization network, L.A. Care Health Plan, to treat the county's 1.2 million recipients of Medi-Cal, the state's Medicaid program. Medicaid services will be administered under a managed care system that consists of L.A. Care and a commercial HMO, FHS, that compete against each other for enrollees. L.A. Care consists of six private and one public managed care health providers., Despite initial applause, the future of L.A. County's two-plan model for serving Medicaid beneficiaries remains uncertain There was much rejoicing in April when L.A. Care Health Plan, one of two [...]

Several provider systems were forced to sell their health maintenance organizations (HMOs) to large for-profit managed-care organizations in 1996 in the face of stiff competition, mergers and buyouts in the healthcare industry. Despite the pressure to sell, some not-for-profit plans have vowed not to sell, although they made smaller profits or posted losses., HMOs, PPOs in flux as buyouts, mergers, competition take a toll on the market As market competition continued to take its toll in the past year, several provider systems sold [...]

Managed care providers are trying to improve their public image, which continues to be poor. However, efforts such as the American Assn of Health Plans' campaign, are considered be some to be a little late and not strong enough. The managed care industry was hit with a spate of negative publicity and a blitzkrieg of legislation in 1996. Some industry observers feel that managed care providers' only choice may be to embrace legislation that favors them the best.

Cigna HealthCare (Hartford, Connecticut) is often left off of lists of the 10 largest managed-care companies, and yet it leads all others by revenue, generating $15.4 billion in 1996. With the firm's announced purchase of Healthsource, revenues are set to rise to $19.2 billion. Cigna is characterized by a conservative but successful financial approach, by a relatively clean public relations record, and by heavy investments in a medical management information infrastructure., Among managed-care plans, Cigna HealthCare is the biggest and most-often overlooked. Managed-care companies are not created equal. More than 1,000 managed-care enterprises operate in the U.S. They differ widely in [...]

Six different states have passed or are considering Medicaid reform legislation. Alabama will instigate a network for Medicaid recipients that partners health maintenance organizations with traditional public health care providers. Alaska will launch two pilot programs in April 1997, one which gives Medicaid recipients immediate access to a registered nurse with a phone call, and another that puts case managers in charge of clinically complex patients. The other state initiatives are in Arkansas, Idaho, Kentucky, and South Dakota., HHS has approved Alabama's application for a five-year Medicaid waiver, allowing the state to implement a Medicaid reform plan that will move recipients into a managed-care network for their healthcare [...]

The 62 independent Blue Cross and Blue Shield Association-affiliated health insurance plans provide healthcare coverage to 63.3 million people. To enhance their competitiveness in a healthcare market increasingly characterized by the use of managed care, the plans are taking a wide variety of proactive business measures, including consolidation, conversion to for-profit status and alliances with private-sector providers., Consumer advocates and industry observers say the rash of Blues conversions is siphoning billions earned as taxpayer-supported companies into executives' and investors' pockets--money that belongs in the communities the plans [...]

Profiles of 12 top healthcare industry executives and public health civil servants aged 40 and younger are presented. Horizon Healthcare VP Kevin Hahn, Hackensack Univ Medical Center VP Robert Garrett, Research Medical Center CFO Katherine E. DeGrande, Watts Health Foundation Exec VP Rodney Armstead, AMA VP Barbara Harness, Atlanta Ear, Nose & Throat Assoc Administrator Lawrence P. Kraska, Lake Hospital System COO Cynthia Moore-Hardy, Marion Country, IN Health Dept. Exec Dir E. Mitchell Roob, Jr., Allegis Health Services Exec VP Gary Sudhalter, Tenet Healthcare Corp. Venture Development Dir Jacinita E. Titiali, Colorado Dept of Health Care Policy & Financing Exec Dir Alan Weil and Chisago Health Services Pres Scott Wordelman., RODNEY ARMSTEAD, M.D. 40 EXECUTIVE VICE PRESIDENT AND CHIEF HEALTH OFFICER, WATTS HEALTH FOUNDATION AND UNITED HEALTH PLAN They're bright, focused and aggressive. They're on a mission to improve the [...]

Healthcare Association of Southern California regional VP Anthony Abbate reports that 16 healthcare consortiums negotiated contracts with the Los Angeles County (California) Department of Health Services (DHS) to provide healthcare services during the summer of 1996. The semi-privatization was necessitated by the need to revitalizing Los Angeles County's healthcare system. The DHS's new Outpatient Expansion Plan will provide services to country residents at 35 private clinics., From the boroughs of New York to the barrios of Los Angeles, public healthcare is getting a makeover. Financially squeezed municipalities are turning to the private sector for help in [...]

Hospital systems that started health maintenance organizations (HMOs) as a way to regain control of health care decisions from insurers are beginning to sell their HMOs. The systems want to focus on delivering care through their preferred-provider organizations (PPOs). Some systems are entering partnerships with large HMOs. However, the larger trend continues to see hospital systems launching HMOs. A 1996 survey of 182 systems showed 49 own HMOs, compared to 15 in 1985. Enrollment and income data for HMOs and PPOs are presented., HMO/PPO survey data indicate more health plans may go on selling block The conflicting pressures of owning provider networks and an HMO are pushing some multi-hospital systems into selling off [...]

California HMOs, facing a saturated market at home, are expanding to other states, where HMO penetration is not as great. The migration promises to allow them to do what they can no longer do in California: compete on the basis of products and services. Health Systems International and other California HMOs are still far from achieving national penetration, and they face obstacles, such as capitation-wary physicians and the perception that HMOs provide substandard care.

Profiles of one dozen up and coming young executives in the healthcare industry are presented. All the profiled executives are younger than 40 years old. Profiled executives include SSM Health Care System Sr VP-Finance Elizabeth Alhand, who is 39 years old; University of Missouri-Kansas City School of Medicine Administrative Officer Donald R. Smithburg; Medica Pres & Allina Health System Group Health Plans VP David Strand, 39; Geisinger Health Care System Easter Region CFO Thomas P. Sokola, 38; and FHP Health Care Colorado Region VP Britt Travis, 36.5

Kaiser Permanente is taking steps to recover lost market share and counter the rapid growth of competing HMOs. The Oakland, CA-based company has 6.6 million enrollees, but growth has been disappointing compared to newer HMOs that have been able to offer lower premiums than Kaiser. Kaiser is looking to expand through acquisition, something it has not done since 1988, but will primarily focus on improving integrated healthcare delivery.

The Portland, OR, healthcare market is one of the most competitive markets nationwide. The Legacy Health System, Kaiser Permanente, Sisters of Providence and Oregon Health Sciences University, Portland's most important heath systems, have increased their healthcare market shares, formed alliances with physician groups and strengthened their relationships with HMOs. Portland's 17 hospitals are considered cost centers and their profit margins are in the 4% to 7% range.

Preferred provider organizations (PPOs) need to adopt innovative strategies to strengthen their operations and increase their profitability. The number of PPO plans increased to 1,107 in October 1994 from 895 in October 1993, and plan enrollment increased 14.7% to 7.1 million in 1994 from 6.2 million in 1993. PPOs plan to form health maintenance organizations and get more involved in the healthcare utilization management process.

More HMOs are signing Medicare risk-sharing contracts, intent on capitalizing on a neglected market. Still, HMOs are hesitant to enter into such arrangements because of uncertainty over the future of Medicare reimbursement. One incentive is proposed legislation that would soften commercial-service prerequisites for managed-care Medicare. In the meantime the concept is reducing hospital stays significantly.

The state of Alaska is a relative newcomer to managed care, but anticipated competition is changing that. It used to be that a few providers served wide geographical areas, with few rivals for the territory. However, insurers may now be willing to fly patients to cities where medical costs are lower. Aetna Health Care Plans Inc is in the process of establishing preferred provider organization arrangements with hospitals in Anchorage, Fairbanks and Juneau. As yet, there are no health maintenance organizations in Alaska, but observers say that capitation is certain, starting with the state's Medicaid program. Additional details of managed care in Alaska are given.

The US' 69 Blue Cross and Blue Shield associations have collectively become the country's largest managed-care organization. The Blues' HMO enrollment reached 7.6 million in 1994, and that enrollment is increasing by 500,000 each year. Managed-care represents some 42% of the Blues' 65.5 million total enrollment. An overview of the Blues' managed-care operations is presented.

Eleven talented healthcare executives are profiled. The institutions represented include South Bay Hospital, Sun City Center, FL; Children's Hospital of the King's Daughters, Norfolk, VA; Memorial Hospital, Dumas, TX; St. David's Health Care System, Austin, TX; Freeman Hospital, Joplin, MO; FHP International, Fountain Valley, CA; St. Mary's Hospital, East St. Louis, IL; Meridia Health System, Mayfield, OH; Quorum Health Group, Brentwood, TN; Central Vermont Medical Center, Barre, VT; and Cascade Vascular Associates, Tacoma, WA.

Integrated healthcare delivery systems, or physician-hospital organizations, (PHOs) combine doctors, hospitals and medical services. These entities contract with insurance companies and health maintenance organizations (HMOs) and they accept capitation fees. Ernst & Young is preparing reports on 250 PHOs, their finances and the outlook for regulation. The administrative problems met by several such organizations are discussed.

Dining in downtown Los Angeles--both the food and the ambiance--is is a delightful mix of the traditional and the boldly now. And can't the same be said--as you who come [...]

Business Insurance's annual guide to alternative risk financing facilities is presented. The guide lists 87 alternative risk financing facilities that wrote a combined premium of $2.59 billion for over 17,000 policyholders in 1992. The 87 facilities had assets of $11.86 billion and policyholder capital and surplus of $6.38 billion at the end of 1992. Individual listings include the facility's name, address and telephone number and a point-of contact. The listings contain information on the risks covered by the firm and policy limits and includes company information on premium volume, assets and the number of policyholders.

Insurance industry executives report that premium rate hikes for property insurance are sticking and that the casualty insurance market is very competitive. The boost in property insurance rates is being attributed to higher rates for catastrophe reinsurance in light of such major natural disasters as Hurricane Andrew. In addition to the property market involving catastrophe exposures, market segments that have seen large increases include aviation, oil and petrochemicals and financial lines.

The market in pollution liability insurance is expanding as large insurance companies offering broad-based environmental liability coverage continue to enter the market. Zurich American Insurance Group is the latest large insurer to enter the pollution liability market. The two major insurers that are already in the market, American International Group Inc and Reliance Group Holdings Inc, are expanding their coverage, increasing limits, and marketing products overseas. United Coastal Insurance, a small insurer, also has expanded its pollution liability coverage.

The market in pollution liability insurance has become stronger as prices have stabilized and businesses become more cognizant of the need for environmental liability coverage. New governmental regulations, stricter lending requirements, and new contractual provisions have fueled the market for pollution liability insurance. The new legal environment has created a market for niche products. Firms offering niche products for sudden and gradual pollution claims include ERIC Group Inc, Environmental Insurance Services Inc, and Environmental Warranty Inc.

California Proposition 166 would require employers to provide health care benefits to employees and their dependents for any employee that works a minimum of 17.5 hours a week or 70 hours a month. The requirements would affect all firms employing 25 or more employees. Proposition 166 is being sponsored by the California Medical Association and is being opposed by a coalition of health insurance companies, business, labor unions, and California Insurance Commissioner John Garamendi. Opponents of Proposition 166 claim that it will cause a net loss of 375,000 jobs and fault it for not containing effective cost controls.

A survey by Interstudy found that open-ended health maintenance organization sign-up growth has slackened but it still surpasses increases in traditional health maintenance organization sign-ups. Enrollment figures for Jan 1991 to Jan 1992 found open-ended health maintenance organization membership rose from 1.2 to 1.5 million people, an increase of almost 25%. Enrollment figures for Jan 1990 to Jan 1991 found organization membership rose from 858,000 to 1.2 million, an increase of 39.5%. Enrollment figures for traditional health maintenance organizations from Jan 1991 to Jan 1992 rose to 36.1 million from 34.1 million, an increase of only 5.9%.

Byline: LOUISE KERTESZ Struggling with lean budgets, many employers are delaying consulting projects unless legally required work can't be performed in-house or potential short-term savings outweigh the costs, benefit managers [...]

Humana has come a long way from its earlier incarnation as a hospital company. Having shed its hospitals and the bulk of its clinics, the insurer is bent on keeping [...]

As more employers offer employees a choice of health plans, the challenge for managed-care companies is not only to attract enrollees but to retain them. Consumer loyalty has become of [...]