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Managed Care

NATIONAL
December 9, 2005 | John-Thor Dahlburg, Times Staff Writer
Florida lawmakers Thursday approved ambitious changes in the state's Medicaid program that call for beneficiaries to contract with private companies that would determine what healthcare, and how much of it, they received. In what could become a model for other states plagued by increases in Medicaid costs, Gov. Jeb Bush wants the program that serves 2.2 million poor, disabled and elderly Floridians to be run more like a private insurance plan.
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BUSINESS
November 9, 2005 | Debora Vrana, Times Staff Writer
With their 4-year-old son's life at stake, Mark and Kimberly Zembsch filed suit this week against Health Net, contending that the Woodland Hills-based HMO had refused to let the youngster see the one doctor they believe can treat his rare condition. Jack suffers from metatrophic dysplasia, which causes the spine to twist as its grows, damaging internal organs. The boy lives in Moraga, east of Oakland, but the doctor his parents consider an expert in the disease practices in Delaware.
NATIONAL
October 20, 2005 | From the South Florida Sun-Sentinel
Florida Gov. Jeb Bush's plan to test a new kind of Medicaid coverage in two counties won federal approval Wednesday. U.S. Health and Human Services Secretary Mike Leavitt approved the state's application for a Medicaid waiver, which still needs final endorsement from the Florida Legislature.
BUSINESS
September 14, 2005 | Debora Vrana, Times Staff Writer
California's 10 largest HMOs continue to have "critical shortfalls" and mediocre results in providing preventive care, although overall quality of care has improved and members are increasingly satisfied with their plans, said state officials who released an annual HMO "report card" Tuesday. The annual survey by the state Office of the Patient Advocate rated Kaiser Permanente's Southern California operation the highest, with 10 out of a possible 12 stars.
CALIFORNIA | LOCAL
September 7, 2005 | Jordan Rau, Times Staff Writer
State leaders on Tuesday put off until next year highly controversial plans to move 554,000 elderly, blind and disabled Medi-Cal beneficiaries into managed care, costing California $90 million in federal incentives. The decision was part of an overall agreement about how to divvy up $18 billion in new federal funding over the next five years in a way that would ensure no hospital loses money. The Legislature is expected to approve the deal by the end of this week.
CALIFORNIA | LOCAL
June 23, 2005 | Jordan Rau and Charles Ornstein, Times Staff Writers
Half a million elderly, blind and disabled Californians now enrolled in Medi-Cal -- including all of those in Los Angeles County -- would be shifted into managed care as part of a complex deal with the federal government, the Schwarzenegger administration announced Wednesday. The pact dictates how California can spend $18.4 billion in Medicaid money over five years and amounts to an overhaul of hospital financing in the state.
BUSINESS
April 9, 2005 | Lisa Girion, Times Staff Writer
HMOs, once the top choice for Americans who get healthcare as a job perk, are so last century. Tightly controlled health maintenance organizations have steadily lost ground over the last decade to preferred provider organizations, which offer greater choice of physicians and hospitals and direct access to specialists -- though at a higher price.
BUSINESS
October 1, 2004 | Lisa Girion, Times Staff Writer
None of California's biggest health maintenance organizations excels at meeting all of the needs of its members, according to a "report card" released Thursday by the state's Office of the Patient Advocate. But HMOs and consumer advocates -- who rarely see eye to eye -- give the state's fourth annual survey poor grades for leaving out key information that could help people better choose a health plan. "It's not that we don't agree with the goal of providing ...
BUSINESS
August 12, 2004 | From Associated Press
Surging healthcare costs have prompted a return to some unpopular money-saving measures that were scaled back after the backlash against managed care during the late 1990s, according to a new study. Requirements such as referrals for specialists and pre- authorizations for some medical services are quietly reappearing in some health plans, according to the study, released Wednesday and published in the policy journal Health Affairs.
HEALTH
May 24, 2004 | Jane E. Allen, Times Staff Writer
Co-payments for prescription drugs may seem like a relatively minor expense; after all, many people must foot the entire bill for their medicine. But raising those payments, especially for folks who take several medications a day, can have a dramatic effect on even the privately insured. Doubling out-of-pocket expenses for medications reduces the use of drugs for such chronic ailments as diabetes, asthma and ulcers by as much as 23%, researchers have found.
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