Driving Down Health Care Costs 1995: Strategies and Solutions
Morehart, Thomas B., Journal of Risk and Insurance
Driving Down Health Care Costs 1995: Strategies and Solutions (Panel Publishers: A Division of Aspen Publishers, Inc, 1995).
Driving Down Health Care Costs 1995: Strategies and Solutions is one in a series of "how-to" books published by Panel Publishers designed to assist business professionals, owners of small to medium-sized businesses, and their legal and financial advisers. This book and the others in the series are designed to be updated on a periodic basis with supplements reflecting important changes in the subject matter. Fifty-seven authors contributed the 45 articles contained in this text. Twenty of the articles are reprinted from a variety of publications, including Compensation and Benefits Management, Employee Benefits Journal, and Benefits Quarterly. The other 25 articles appear to be original works authored specifically for this book. The book's 474 pages are divided into 13 sections, each of which covers an important topic dealing with health care costs and related strategies and solutions.
Part One addresses three important issues related to reform. The first article presents a comparison of issues raised by the 1993 Clinton Health Security Act and contains two appendices with specific comparisons of the Clinton proposal with several other proposals from 1993. The other two articles present an overview of state health reform activity and a picture of the dramatic recent evolution in the entire health care delivery system. Part Two presents eight articles related to managed care. Two articles on HMOs deal with trends in HMO development and Digital Equipment Corporation's approach to managing HMOs. The other articles focus on some important managed care topics, including employer liability and the legal risks associated with managed care plans, the success of the Federal Employees Health Benefits Program, case management, utilization management, and pay-related plans.
Part Three focuses on the emerging roles of employers in dealing with rising health care costs. The first article examines how GTE managed to avoid severe cutbacks in its benefits plan by making strategic changes to its plans, including changes in the management of payments and an evaluation process to measure costs and quality. A unique step was the formation of a partnership between GTE and PHP Healthcare Corporation of Alexandria, Virginia, to establish and manage two GTE Family Health Centers in the Tampa, Florida, area. The next article deals with how employers in Owatonna, Minnesota, a rural community of about 22,000 people, dealt with many of the problems facing them from rising health care costs. Another article describes how self-management of health care by Parker Hannifin, a Fortune 200 company with 20,000 employees, has led to lowering the rate of increase in employee health benefit costs. The last article in this section discusses how coalitions of human resources executives in approximately 100 cities have used their combined purchasing power to try to improve the quality of health care and its cost-effectiveness.
Part Four describes the flexible benefits plans of Quaker Oats and Southwest Airlines. Part Five discusses some important aspects of self-insurance, including the use of self-insurance and stop-loss coverage by smaller companies, the law related to retrospective insurance premiums, and issues related to third-party administrators regarding flexible benefits and self-insurance. Part Six focuses on the elements of effective plan design. The articles in this section describe ways to reduce medical costs using employee claims data, use drug formularies to control drug budget costs, save through inventory simplification and volume purchasing, and use the resource-based relative value scale (RBRVS) to help control physician costs. Also discussed are how dental plans have remained strong despite changes and cutbacks in medical benefit plans and the cost-effective steps that have been taken by some employers related to AIDS and HIV. …