Managed Care Symposium Sponsored By Society Of Actuaries Examines HEDIS, Stakeholders' Views

SCHAUMBURG, Ill.-- Is quality really HMO members' Number 1 concern? How can managed care effectiveness be measured given the widely varying views of stakeholders? What are the pluses and pitfalls in one such tool, the Health Plan Employer Data and Information Set (HEDIS)?

These are among the questions addressed at a recent Society of Actuaries symposium, "Managed Care in a Time of Transition." Final edited transcripts of the symposium's sessions are expected to be offered publicly this winter. Advance transcripts are available now. Contact Jackie Bitowt, Society of Actuaries, (847) 706-3566, jbitowt@soa.org.

Highlights from the symposium include the following presentations. Overview and keynote address by Jeffrey Nohl, senior vice president, strategic planning and marketing services, Wisconsin Physician Services, Madison, Wis. Nohl's central vision of managed care is, "As much as HMOs and managed care organizations insisted they would be different than the traditional insurance companies that sired them, they have become their parents." Nohl also observes, "When Humana Health Care surveyed its members ... (Humana) discovered only one thing really mattered to consumers, and it was not quality. It was access. ... Most people already assume they are receiving quality health care from any licensed professional who's regulated by the state."

"What is Effective Managed Care?," Jill Schield, Northwestern University researcher; Alan Rosenberg, M.D., quality management and medical director, Aetna Health Plans, Chicago; James Murphy, consulting actuary, Howard Johnson & Co., Seattle (moderator). At the symposium, Schield stated: "HMOs are in it for the money (but) that can be said of every stakeholder. ... The question we are asking is, are all the changes and challenges facing stakeholders ultimately resulting in high-quality, low-cost medical care that improves the overall health of the po

Contact: Jacqueline Bitowt
(847) 706-3566
Society of Actuaries

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