Word: hmo
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...longer, he claimed, would Aetna U.S. Healthcare require Connecticut doctors to participate in all its plans, from HMO and Medicare to more flexible preferred-provider organizations (PPO); physicians with 100 or fewer HMO members would now be paid for each patient they saw, rather than with a flat, monthly rate under the hated system known as capitation, which in practice compelled doctors to ration care if they wanted to make any money. And patients with chronic conditions would now be able to use specialists as their primary-care physicians...
...last; he's already struck a deal with the Texas attorney general making similar concessions. Since taking over a few months ago from Richard Huber, the combative CEO who was forced out, Donaldson has been trying his best to mend the HMO giant's sickly relations with doctors and members, who view it as putting profits ahead of patients...
Even if Donaldson can diffuse those issues, he doesn't possess a miracle cure for Aetna's woes. The company needs to increase its profits, but the public backlash against managed care has made it all but impossible to cut costs any more. HMO enrollment is slowing; medicare reimbursements are too low; and hospitals and doctors are fighting back against deep fee discounts--in some cases dropping out of networks altogether. More people are opting for flexible plans, choosing preferred-provider organizations over HMOs (see sidebar). Says Tom Ferguson, a health-care consultant at William M. Mercer: "There's less...
...because the resource is geared to students alone--no HMO patients or retirees--the BSC sees around the same number of students as UHS, just for longer periods of time and more regularly...
...when Harvard Pilgrim Health Care was threatened with financial ruin, Grogan offered the state attorney general a plan to keep the troubled HMO--and Harvard namesake--afloat...