title: An empty toolbox? Changes in health plans' approaches for managing costs and care.
abstract: OBJECTIVE
  To examine how health plans have changed their approaches for managing costs and utilization in the wake of the recent backlash against managed care.
  
  
  METHODS
  Semistructured interviews with health plan executives, employers, providers, and other health care decision makers in 12 metropolitan areas that were randomly selected to be nationally representative of communities with more than 200,000 residents. Longitudinal data were collected as part of the Community Tracking Study during three rounds of site visits in 1996-1997, 1998-1999, and 2000-2001.
  
  
  METHODS
  Interviews probed about changes in the design and operation of health insurance products--including provider contracting and network development, benefit packages, and utilization management processes--and about the rationale and perceived impact of these changes.
  
  
  METHODS
  Data from more than 850 interviews were coded, extracted, and analyzed using computerized text analysis software.
  
  
  RESULTS
  Health plans have begun to scale back or abandon their use of selected managed care tools in most communities, with selective contracting and risk contracting practices fading most rapidly and completely. In turn, plans increasingly have sought cost savings by shifting costs to consumers. Some plans have begun to experiment with new provider networks, payment systems, and referral practices designed to lower costs and improve service delivery.
  
  
  CONCLUSIONS
  These changes promise to lighten administrative and financial burdens for physicians and hospitals, but they also threaten to increase consumers' financial burdens.
authors.affiliation: Center for Studying Health System Change, Washington, DC, USA.
authors.forename: Glen P
authors.initials: GP
authors.lastname: Mays
authors.forename: Robert E
authors.initials: RE
authors.lastname: Hurley
authors.forename: Joy M
authors.initials: JM
authors.lastname: Grossman
mesh_terms: D003284:Contract Services / Q000191:economics / Q000639:trends; D032982:Contracts; D003365:Costs and Cost Analysis / Q000191:economics / Q000639:trends; D020793:Gatekeeping / Q000639:trends; D018166:Health Care Reform / Q000191:economics / Q000639:trends*; D006302:Health Services Research; D006801:Humans; D007342:Insurance Benefits / Q000191:economics / Q000639:trends; D008137:Longitudinal Studies; D008329:Managed Care Programs / Q000191:economics* / Q000639:trends*; D012308:Risk Management / Q000191:economics / Q000639:trends; D014481:United States; D014600:Utilization Review / Q000379:methods