Jove
Visualize
Contact Us
JoVE
x logofacebook logolinkedin logoyoutube logo
ABOUT JoVE
OverviewLeadershipBlogJoVE Help Center
AUTHORS
Publishing ProcessEditorial BoardScope & PoliciesPeer ReviewFAQSubmit
LIBRARIANS
TestimonialsSubscriptionsAccessResourcesLibrary Advisory BoardFAQ
RESEARCH
JoVE JournalMethods CollectionsJoVE Encyclopedia of ExperimentsArchive
EDUCATION
JoVE CoreJoVE BusinessJoVE Science EducationJoVE Lab ManualFaculty Resource CenterFaculty Site
Terms & Conditions of Use
Privacy Policy
Policies

Related Experiment Videos

Manage authorizations to manage care

P L Grimaldi

    Nursing Management
    |April 1, 1996
    PubMed
    Summary
    This summary is machine-generated.

    Managed care organizations use varying methods to authorize services, with primary care physician involvement being key. Tighter management systems are more effective in preventing unnecessary medical spending.

    Related Concept Videos

    You might also read

    Related Articles

    Articles linked to this work by shared authors, journal, and citation graph.

    Sort by
    Same author

    Submento-submandibular intubation: is the subperiosteal passage essential? Experience in 107 consecutive cases.

    The British journal of oral & maxillofacial surgery·2005
    Same author

    Medicare's new home health prospective payment system explained.

    Healthcare financial management : journal of the Healthcare Financial Management Association·2001
    Same author

    Unraveling Medicare's prospective payment system for hospital outpatient care.

    Journal of health care finance·2001
    Same author

    Can Medicare beneficiaries pay outpatient drug bills?

    Nursing management·2000
    Same author

    New managed-care glossary.

    Nursing management·2000
    Same author

    New risk adjustment may cut Medicare payments.

    Nursing management·1999

    Area of Science:

    • Healthcare Management
    • Health Economics
    • Medical Economics

    Background:

    • Managed care organizations (MCOs) employ diverse strategies for authorizing healthcare services.
    • The extent of primary care physician (PCP) involvement in the authorization process varies significantly across MCOs.
    • These differences impact the efficiency and cost-effectiveness of healthcare delivery.

    Purpose of the Study:

    • To analyze the impact of different managed care authorization methods on healthcare costs.
    • To determine the role of primary care physicians in controlling utilization and costs within managed care systems.

    Main Methods:

    • Comparative analysis of managed care organization (MCO) authorization protocols.
    • Evaluation of the relationship between PCP gatekeeping roles and healthcare service utilization.

    Related Experiment Videos

  • Assessment of cost-saving outcomes associated with different levels of managed care oversight.

    • Main Results:

    • MCOs utilizing stricter authorization processes, particularly those with significant PCP involvement, demonstrate greater success in cost containment.
    • Systems with enhanced primary care physician (PCP) oversight show a higher likelihood of avoiding unnecessary medical expenditures.
    • The degree of "tightness" in managed care management directly correlates with the potential for cost avoidance.

    Conclusions:

    • The primary care physician (PCP) plays a critical role in managing healthcare costs within managed care organizations (MCOs).
    • Implementing tightly managed authorization systems, centered around PCP referrals, is an effective strategy for reducing unnecessary medical spending.
    • Optimizing PCP roles in managed care authorization can lead to significant healthcare economic benefits.