Word: hmos
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...trend has won the attention of a few HMOs, federal and state government officials and gym-equipment manufacturers--which are now marketing more air-pressurized weight machines with larger digital displays. Health clubs--traditional havens for beefy bodybuilders but more recently shifting to an emphasis on overall wellness--are beginning to respond. This year some 65% of health clubs offer some sort of senior-fitness program, up from 32% 10 years ago, according to the International Health, Racquet and Sportsclub Association, the trade association for health clubs. Trainers say seniors are often their most eager, dedicated and appreciative clients...
Most compelling for advocates is the slow-growing attention senior fitness is attracting from managed care. For years, HMOs have offered 10% discounts on health-club memberships, primarily as a marketing tool. Based in Phoenix, Ariz., the company HealthCare Dimensions, which sells and administers a comprehensive senior-fitness program called Silver Sneakers, has taken the lead in getting HMOs to sign up for real intervention. By providing quality assurance and initial research summaries indicating regular exercisers have significantly reduced claims, HealthCare Dimensions has signed up 13 major HMOs from Florida to Oregon to fully cover the cost...
This summer a new outfit called MedUnite will try to close the loop. Formed by large insurers, including Aetna, Cigna and Oxford, that didn't like the idea of WebMD coming between them and their core customers, MedUnite will try to offer intelligent connectivity to doctors and HMOs in order to speed claims, referrals and eligibility checks--and to cut costs. "Who better to work out the relationship with HMOs than the HMOs themselves?" asks Dave Cox, MedUnite...
Most physicians have a quick answer: almost anybody else. Given managed care's sorry record, it's easy to see how doctors might be just a bit skeptical. While the administrative savings could be big for HMOs, they still earn 10% to 30% of their profits from the float--the interest on holding onto their premiums for an extra 30 to 90 days. At the same time, industry coalitions like MedUnite often collapse...
Given the decreased control patients currently have over their own health care, the threat of litigation is a necessary means of ensuring the accountability of HMOs. Without sufficient legal recourse for improperly denied care, patients often find themselves at the mercy of insurance companies. The McCain-Kennedy bill would go a long way toward placing patients on more solid ground when dealing with their HMOs, permitting up to $5 million in punitive damages to be awarded in state courts. The threat of court intervention will promote integrity in an industry where it is most desperately needed...