managed care programs
Summary: Health insurance plans intended to reduce unnecessary health care costs through a variety of mechanisms, including: economic incentives for physicians and patients to select less costly forms of care; programs for reviewing the medical necessity of specific services; increased beneficiary cost sharing; controls on inpatient admissions and lengths of stay; the establishment of cost-sharing incentives for outpatient surgery; selective contracting with health care providers; and the intensive management of high-cost health care cases. The programs may be provided in a variety of settings, such as HEALTH MAINTENANCE ORGANIZATIONS and PREFERRED PROVIDER ORGANIZATIONS.
Publications292 found, 100 shown here
- Are managed care Medicare beneficiaries with chronic conditions satisfied with their care?Nadereh Pourat
University of California, Los Angeles, USA
J Aging Health 18:70-90. 2006..This article compares patient experiences of chronically ill older people in health maintenance organizations (HMOs) with other forms of Medicare supplemental coverage...
- Access to appointments based on insurance status in Washington, D.CJanice Blanchard
George Washington University Medical School, USA
J Health Care Poor Underserved 19:687-96. 2008..001 compared with private). Access to primary care follow-up is poor in the District of Columbia for all types of insurance; however people with Medicaid fee-for-service and the uninsured face especially strong barriers...
- Health behaviors and quality of care among Latinos with diabetes in managed careArleen F Brown
School of Medicine at the University of California, Los Angeles, CA 90095, USA
Am J Public Health 93:1694-8. 2003..We evaluated whether ethnicity and language are associated with diabetes care for Latinos in managed care...
- Tobacco-control policies in 11 leading managed care organizations: progress and challengesNancy A Rigotti
Tobacco Research and Treatment Center, Massachusetts General Hospital, Harvard Medical School, Harvard Pilgrim Health Care, Boston 02114, USA
Eff Clin Pract 5:130-6. 2002..Although evidence-based national guidelines for tobacco-dependence treatment have been available since 1996, translating these guidelines into clinical practice is challenging...
- Quality information and consumer health plan choicesNancy Dean Beaulieu
Harvard University and the National Bureau of Economic Research, Harvard Business School, Boston, MA 02163, USA
J Health Econ 21:43-63. 2002..The age of the policyholder and the type of policy purchased moderated the effects of plan characteristics on plan choice in ways that may be consequential for adverse selection...
- Functional health outcomes as a measure of health care quality for Medicare beneficiariesA S Bierman
Center for Outcomes and Effectiveness Research, Agency for Healthcare Research and Quality, Rockville, MD 20852, USA
Health Serv Res 36:90-109. 2001..To interpret the HOS as a quality measure individual-and plan-level differences in functional status and illness burden, as well as methodologic issues in health status measurement, need to be recognized and addressed...
- Tobacco control efforts in managed care: what do the doctors think?Leif I Solberg
HealthPartners Research Foundation, Minneapolis, Minn 55440 1524, USA
Am J Manag Care 10:193-8. 2004....
- The commercial health insurance industry in an era of eroding employer coverageJames C Robinson
School of Public Health, University of California, Berkeley, USA
Health Aff (Millwood) 25:1475-86. 2006..The profitability of the commercial health insurance industry, exceptionally strong over the past five years, will henceforth be linked to the budgetary cycles and political fluctuations of state and federal governments...
- Health outcomes. New quality measure for MedicareJ K Cooper
Health Care Financing Administration, Baltimore, MD 21244 1850, USA
Int J Qual Health Care 13:9-16. 2001..A new measurement of health care quality for Medicare beneficiaries has been implemented by the Health Care Financing Administration (HCFA). This paper describes the program, presents baseline data and highlights associated issues...
- The role of health plans in tobacco controlMarc W Manley
Blue Cross and Blue Shield of Minnesota, Center for Tobacco Reduction and Health Improvement, Eagan, Minnesota 55121, USA
Annu Rev Public Health 24:247-66. 2003..We conclude with a new model that can be used to engage health plans in tobacco control efforts and a case study that outlines how one health plan has implemented this new model...
- The impact of managed health care in the United States on women with breast cancer and the providers who treat themJoretha N Bourjolly
University of Pennsylvania, School of Social Work, Philadelphia, Pennsylvania 19104, USA
Cancer Nurs 27:45-54. 2004..Findings from this pilot study, however, reveal that the increasing shift to managed care has resulted in a change in roles for nurses, fragmentation of care, and intangible costs to the patients...
- Addressing tobacco in managed care: results of the 2003 surveyCarol McPhillips-Tangum
Experion Healthcare Group, 106 Geneva St, Decatur, GA 30030, USA
Prev Chronic Dis 3:A87. 2006..Although tobacco control activity in the United States during the past several years has increased dramatically, tobacco use continues to have devastating consequences among all age cohorts...
- The financial implications of coverage of smoking cessation treatment by managed care organizationsKenneth E Warner
Department of Health Management and Policy, University of Michigan School of Public Health, Ann Arbor, MI 48109 2029, USA
Inquiry 41:57-69. 2004..Quitters gain an average of 7.1 years of life, with a direct coverage cost of dollars 3,417 for each life-year saved. Coverage of cost-effective programs by MCOs should be strongly encouraged...
- Outcomes and lessons learned from evaluating TRICARE's disease management programsTimothy M Dall
The Lewin Group, Falls Church, VA 22042, USA
Am J Manag Care 16:438-46. 2010..To share outcomes and lessons learned from an evaluation of disease management (DM) programs for asthma, congestive heart failure (CHF), and diabetes for TRICARE patients...
- Disease management 360 degrees: a scorecard approach to evaluating TRICARE's programs for asthma, congestive heart failure, and diabetesWenya Yang
The Lewin Group, Falls Church, VA 22042, USA
Med Care 48:683-93. 2010..EVALUATION MEASURES: Patient healthcare utilization, financial, clinical, and humanistic outcomes. Absolute measures were translated into effect size and incorporated into a scorecard...
- The impact of managed care on children's access, satisfaction, use, and quality of careP W Newacheck
Institute for Health Policy Studies, San Francisco, CA 94118, USA
Health Serv Res 36:315-34. 2001..This conclusion is provisional, however, because of limitations in the data set...
- Plan choice and changes in access to care over time for SSI-eligible children with disabilitiesPamela N Roberto
US Government Accountability Office, USA
Inquiry 42:145-59. 2005..Possible explanations for the deterioration in access associated with FFS include the lack of case management services, lower reimbursement relative to the partially capitated managed care plan, and provider availability...
- A multisite randomized trial of the effects of physician education and organizational change in chronic-asthma care: health outcomes of the Pediatric Asthma Care Patient Outcomes Research Team II StudyPaula Lozano
Center for Health Studies, Group Health Cooperative, 1730 Minor Avenue, Seattle, WA 98101, USA
Arch Pediatr Adolesc Med 158:875-83. 2004..Traditional primary care practice change approaches have not led to full implementation of national asthma guidelines...
- Satisfaction with services in innovative managed care programs for groups of traditionally underserved individuals with HIV/AIDS: empirical modelsD A Cherin
Measurement Group, 5811A Uplander Way, Culver City, CA 90230, USA
Home Health Care Serv Q 19:103-25. 2001..Through the modeling methods, the groups most likely to experience the greatest program satisfaction are identified. In general, all groups were highly satisfied with the programs...
- Patients' trust in physicians: many theories, few measures, and little dataS D Pearson
Center for Ethics in Managed Care, Harvard Medical School and Harvard Pilgrim Health Care, Boston, MA 02215, USA
J Gen Intern Med 15:509-13. 2000..The gaps identified in our knowledge about trust can help target new efforts to strengthen the methodological basis of work to understand this vital element of medical relationships...
- Impact of the Oregon Health Plan on children with special health care needsJ B Mitchell
Health Economics Research, Inc, Waltham, Massachusetts 02452, USA
Pediatrics 107:736-43. 2001..This study compares the managed care experiences of children with and without special care needs in the Oregon Health Plan...
- Should the NHS follow the American way?Cam Donaldson
School of Population and Health Sciences, University of Newcastle, Newcastle upon Tyne NE2 4AA
BMJ 331:1328-30. 2005
- Physicians' perceptions of managed care: a review of the literatureJon B Christianson
University of Minnesota, USA
Med Care Res Rev 62:635-75. 2005..The review concludes with suggestions for the conduct of future research on this topic...
- Management of multiple sclerosis across managed care and fee-for-service systemsB G Vickrey
Department of Neurology, University of California at Los Angeles, 90095 1769, USA
Neurology 55:1341-9. 2000..To measure and compare care for adults with MS across managed care and fee-for-service (FFS) health systems...
- Managed care, access to specialists, and outcomes among primary care patients with painDavid E Grembowski
Department of Health Services, School of Public Health and Community Medicine, University of Washington, Seattle 98195-7660, USA
Health Serv Res 38:1-19. 2003....
- Effects of Medicaid managed care on health care use: infant emergency department and ambulatory servicesE A Alessandrini
Division of Emergency Medicine, The Children's Hospital of Philadelphia, USA
Pediatrics 108:103-10. 2001..78) and having a mother who completed high school (OR: 0.67; 95% CI: 0.45, 0.99). CONCLUSIONS: Enrollment in MMC did not alter ED usage patterns when compared with FFSM. Some variation in use of other ambulatory services was detected...
- Inequality of access to surgical specialty health care: why children with government-funded insurance have less access than those with private insurance in Southern CaliforniaEdward C Wang
Department of Otolaryngology, Keck School of Medicine, University of Southern California, Los Angeles, California, USA
Pediatrics 114:e584-90. 2004..Physicians indicate that this disparity is related to excessive administrative burdens and low monetary reimbursement. The implications of our findings on public health care policies are discussed...
- Switching to gatekeeping: changes in expenditures and utilization for childrenT G Ferris
Institute for Health Policy, Division of General Medicine, Massachusetts General Hospital for Children and Harvard Medical School, Boston, Massachusetts 02114, USA
Pediatrics 108:283-90. 2001..Little empirical research describes the impact of switching into a gatekeeping plan on health care expenditures and utilization for children...
- Changes in antibiotic prescribing for children after a community-wide campaignJoseph F Perz
Epidemic Intelligence Service, Epidemiology Program Office, Centers for Disease Control and Prevention, Atlanta, GA, USA
JAMA 287:3103-9. 2002..001]; among black children, 18% [P<.001]). CONCLUSIONS: A community-wide educational intervention reduced antibiotic prescription levels among children in Knox County...
- Managed care and the US health care system a social exchange perspectiveDavid E Grembowski
Department of Health Services, University of Washington, Seattle 98195 7660, USA
Soc Sci Med 54:1167-80. 2002..The theoretical and research implications of exchange theory for the comparative study of health care systems are discussed...
- Impact of 3-tier formularies on drug treatment of attention-deficit/hyperactivity disorder in childrenHaiden A Huskamp
Department of Health Care Policy, Harvard Medical School, 180 Longwood Avenue, Boston, MA 02115, USA
Arch Gen Psychiatry 62:435-41. 2005..Many employers and health plans have adopted 3-tier formularies in an attempt to control costs for these and other drugs...
- Failure of Internet-based audit and feedback to improve quality of care delivered by primary care residentsSteven R Simon
Department of Ambulatory Care and Prevention, Harvard Medical School and Harvard Pilgrim Health Care, 133 Brookline Avenue, 6th Floor, Boston, MA 02215, USA
Int J Qual Health Care 17:427-31. 2005..To determine the effectiveness of Internet-based audit and feedback to physicians to improve care for diabetes and hypertension...
- Managed care, access to mental health specialists, and outcomes among primary care patients with depressive symptomsDavid E Grembowski
Center for Cost and Outcomes Research, Department of Health Services, University of Washington, Seattle, Wash 98195 7660, USA
J Gen Intern Med 17:258-69. 2002..To determine whether managed care is associated with reduced access to mental health specialists and worse outcomes among primary care patients with depressive symptoms...
- Achieving cholesterol target in a managed care organization (ACTION) trialRobert J Straka
Department of Experimental and Clinical Pharmacology, College of Pharmacy, University of Minnesota, Minneapolis, Minnesota 55455, USA
Pharmacotherapy 25:360-71. 2005....
- Predictors of adherence with antihypertensive and lipid-lowering therapyRichard H Chapman
ValueMedics Research, LLC, Arlington, VA, USA
Arch Intern Med 165:1147-52. 2005..This study was undertaken to describe the patterns and predictors of adherence with concomitant antihypertensive (AH) and lipid-lowering (LL) therapy...
- Occurrence of secondary ischemic events among persons with atherosclerotic vascular diseaseBarbara G Vickrey
RAND, Santa Monica, Calif, USA
Stroke 33:901-6. 2002..We estimated the occurrence of secondary stroke, acute myocardial infarction (AMI), and vascular deaths among 2 large, managed care samples...
- Managed care organization characteristics and outpatient specialty care use among children with chronic illnessElizabeth Shenkman
Department of Epidemiology and Health Policy Research, Institute for Child Health Policy, University of Florida, 1329 SW 16th St, Room 5130, Gainesville, FL 32608, USA
Pediatrics 115:1547-54. 2005..Limited information is available about managed care organization (MCO) characteristics that influence outpatient physician specialist use among children with chronic conditions...
- Receipt of asthma subspecialty care by children in a managed care organizationMichael Cabana
Child Health Evaluation and Research CHEAR Unit, Division of General Pediatrics, University of Michigan Health Care System, Ann Arbor 48109 0456, USA
Ambul Pediatr 2:456-61. 2002..Although proper outpatient asthma management sometimes requires care from subspecialists, there is little information on factors affecting receipt of subspecialty care in a managed care setting...
- Effect of increased cost-sharing on oral hypoglycemic use in five managed care organizations: how much is too much?Douglas W Roblin
Research Department, Kaiser Permanente, Atlanta, Georgia 30305, and the Department of Ambulatory Care and Prevention, Harvard Medical School and Harvard Pilgrim Health Care, Boston, Massachusetts, USA
Med Care 43:951-9. 2005..For patients with a chronic disease, increased cost-sharing for medications may lead to unintended consequences, including reduced use of medications essential for control of their disease...
- Pharmacoeconomic evaluation of a pharmacist-managed hypertension clinicM P Okamoto
Department of Pharmacy Practice and Social and Administrative Sciences, Western University of Health Sciences, Pomona, California 91766, USA
Pharmacotherapy 21:1337-44. 2001..To measure clinical, economic, and humanistic outcomes associated with a pharmacist-managed hypertension clinic compared with physician-managed clinics...
- Managed care, professional autonomy, and income: effects on physician career satisfactionJ J Stoddard
Center for Studying Health System Change, Washington, DC, USA
J Gen Intern Med 16:675-84. 2001..The level of career satisfaction derived by physicians from their work is a basic yet essential element in the functioning of the health care system...
- A benefit-based copay for prescription drugs: patient contribution based on total benefits, not drug acquisition costA M Fendrick
Division of General Internal Medicine, Department of Internal Medicine, School of Medicine, University of Michigan, Ann Arbor, MI, USA
Am J Manag Care 7:861-7. 2001..Implementation of such a system would provide a financial incentive for individuals to prioritize their out-of-pocket drug expenditures based on the value of their medications, not their price...
- Are incentive-based formularies inversely associated with drug utilization in managed care?Patrick P Gleason
Prime Therapeutics, LLC, Eagan, MN 55121 3497, USA
Ann Pharmacother 39:339-45. 2005..To review recent studies comprehensively assessing the impact of incentive-based multitier formularies on pharmaceutical costs and utilization...
- Use of geocoding in managed care settings to identify quality disparitiesAllen M Fremont
RAND Health, Santa Monica, California, USA
Health Aff (Millwood) 24:516-26. 2005....
- Association between prescription burden and medication adherence in patients initiating antihypertensive and lipid-lowering therapyJoshua S Benner
Engelberg Center for Health Care Reform, The Brookings Institution, Washington, DC
Am J Health Syst Pharm 66:1471-7. 2009..The association between prescription burden and medication adherence in patients initiating antihypertensive and lipid-lowering therapy was studied...
- Impact of a managed-Medicare physical activity benefit on health care utilization and costs in older adults with diabetesHuong Q Nguyen
Department of Behavioral Nursing and Health Systems, University of Washington, Seattle, WA 98199, USA
Diabetes Care 30:43-8. 2007..The purpose of this article was to determine the effects of a managed-Medicare physical activity benefit on health care utilization and costs among older adults with diabetes...
- Descriptive analysis of the direct medical costs of multiple sclerosis in 2004 using administrative claims in a large nationwide databaseJeff D Prescott
Science and Technology, The MCM Group, 108 I Centre Blvd, Marlton, NJ 08053, USA
J Manag Care Pharm 13:44-52. 2007..Multiple sclerosis (MS) is chronic and debilitating, afflicts patients in the prime of their lives, and requires costly, decades-long disease management. MS prevalence is increasing, and treatment with new drug therapies is expensive...
- Impact of disease management on health care utilization: evidence from the "Florida: A Healthy State (FAHS)" Medicaid ProgramAbdelmonem A Afifi
School of Public Health, UCLA, Los Angeles, CA 90095 1772, USA
Prev Med 44:547-53. 2007..To examine the impact of disease management on utilization of selected health care services...
- The role of managed care and financing in medical practices: how does psychiatry differ from other medical fields?Roland Sturm
RAND UCLA Center on Managed Care for Psychiatric Disorders, 1700 Main Street, Santa Monica, CA 90401, USA
Soc Psychiatry Psychiatr Epidemiol 38:427-35. 2003....
- Validity of the Asthma Control Test completed at homeMichael Schatz
Department of Allergy, Kaiser Permanente, San Diego, Calif, USA
Am J Manag Care 13:661-7. 2007..To provide additional validity data for the Asthma Control TestTM (ACT) using a different criterion measure, setting, and population...
- Optimal design features for surveying low-income populationsDoren D Fredrickson
Department of Preventive Medicine and Public Health, University of Kansas School of Medicine, Wichita, USA
J Health Care Poor Underserved 16:677-90. 2005..0001). Using consumer-based preferences significantly increased response rates to this Medicaid satisfaction survey. Raising CAHPS response rates may increase validity of Medicaid consumer satisfaction information...
- Validation of data collection for the HEDIS performance measure on chlamydia screening in an MCOFeifei Wei
HealthPartners Research Foundation, PO Box 1524, Minneapolis, MN 55440 1524, USA
Am J Manag Care 9:585-93. 2003..To determine the validity of calculating the chlamydia Health Plan Employer Data and Information Set (HEDIS) measure using administrative data available in a mixed-model managed care organization (MCO)...
- Revisiting the relationship between managed care and hospital consolidationRobert J Town
Division of Health Policy and Management, School of Public Health, University of Minnesota, Mayo Mail Code 729, 420 Delaware St SE, Minneapolis, MN 55455, USA
Health Serv Res 42:219-38. 2007..This paper analyzes whether the rise in managed care during the 1990s caused the increase in hospital concentration...
- Changing medication use in managed care: a critical review of the available evidenceSallie-Anne Pearson
Harvard Medical School, Harvard Pilgrim Health Care, 133 Brookline Ave, 6th Floor, Boston, MA 02215, USA
Am J Manag Care 9:715-31. 2003..Few well-designed, published studies have assessed the efficacy or safety of financial incentives for physicians, tiered copayments for patients, or formularies--despite their widespread use...
- Improving asthma management: one health plan's experienceAndrew W Green
Independent Health Association, 511 Farber Lakes Dr, Buffalo, NY 14221, USA agreen independenthealth com
Am J Manag Care 13:482-5. 2007..To demonstrate that including the patient's perspective of disease control (patient-reported symptoms) in asthma treatment and management decisions improves patient outcomes and reduces healthcare resource utilization...
- Adherence with multiple-combination antihypertensive pharmacotherapies in a US managed care databaseKenneth C Jackson
Clin Ther 30:1558-63. 2008..These findings suggest patient compliance improves with simplified pharmacotherapeutic approaches...
- Methadone maintenance and state Medicaid managed care programsD McCarty
Brandeis University, USA
Milbank Q 77:341-62, 274. 1999....
- Managed care, consolidation among health care providers, and health care: evidence from mammographyL C Baker
Stanford University, USA
Rand J Econ 30:351-74. 1999..We also find that increases in HMO market share are associated with reductions in costs for mammography and with increases in waiting times for appointments, but not with worse health outcomes...
- Effects of Medicaid managed care programs on health services access and useBowen Garrett
The Urban Institute, Health Policy Center, Washington, DC 20037, USA
Health Serv Res 38:575-94. 2003..1991-1995 National Health Interview Surveys (NHIS) and a 1998 Urban Institute survey on state Medicaid managed care programs. STUDY DESIGN: Using multivariate regression models, we estimated the effect of living in a county with an ..
- Serum urate levels and gout flares: analysis from managed care dataChaitanya A Sarawate
Health Outcomes Research, HealthCore, Inc, 800 Delaware Avenue, Wilmington, DE 19801 1366, USA
J Clin Rheumatol 12:61-5. 2006..The desired serum urate level (SUA) for prevention of gout attacks is widely recommended to be in the subsaturating range, <6.0 mg/dL...
- Quality of care for secondary prevention for patients with coronary heart disease: results of the Hastening the Effective Application of Research through Technology (HEART) trialDavid C Goff
Public Health Sciences and Internal Medicine, Wake Forest University School of Medicine, Winston Salem, NC 27157 1063, USA
Am Heart J 146:1045-51. 2003....
- A randomized controlled trial of test-and-treat strategy for Helicobacter pylori: clinical outcomes and health care costs in a managed care population receiving long-term acid suppression therapy for physician-diagnosed peptic ulcer diseaseJames E Allison
Division of Research, Kaiser Permanente Medical Care Program, Northern California Region, 2000 Broadway, Oakland, CA 94612, USA
Arch Intern Med 163:1165-71. 2003....
- Evaluation of laboratory monitoring alerts within a computerized physician order entry system for medication ordersTed E Palen
Clinical Research Unit, Colorado Permanente Medical Group, PO Box 378066, Denver, CO 80237 8066, USA
Am J Manag Care 12:389-95. 2006..Few studies have examined the effect of CPOE in combination with decision support tools on prescribing practices in the outpatient setting. Less is known about prescribers' adherence to laboratory monitoring recommendations...
- Gout medication treatment patterns and adherence to standards of care from a managed care perspectiveChaitanya A Sarawate
Health Outcomes Research, HealthCore, Inc, 800 Delaware Ave, Fifth Floor, Wilmington, DE 19801 1366, USA
Mayo Clin Proc 81:925-34. 2006..To determine allopurinol treatment patterns and adherence to published standards of care for patients with gout...
- Eliminating fixed costs: Part I--Health system driversThomas P Weil
Manag Care Interface 15:27-32, 53. 2002..In part I of this two-part article, the author describes some of the drivers that are pushing health care costs to higher levels...
- Do increases in the market share of managed care influence quality of cancer care in the fee-for-service sector?Nancy L Keating
Department of Health Care Policy, Harvard Medical School, Boston, MA 02115, USA
J Natl Cancer Inst 97:257-64. 2005....
- Length of stay at an all-time lowRenee Mardis
Department of Inpatient Rehabilitation, Warren, Mich, USA
Health Care Manag (Frederick) 22:122-7. 2003..Still, the question remains: Does shortened length of stay decrease the quality of care given? Understanding the factors of change and their effect on the medical environment is beneficial to all health care professionals...
- Private insurance and the utilization of chemical dependency treatmentLaura A Schmidt
Alcohol Research Group, Public Health Institute, Berkeley, CA 94709, USA
J Subst Abuse Treat 28:67-76. 2005..Our results concerning Medicare coverage may point to potential problems with making treatment affordable to some problem drinkers outside the private insurance system...
- Monitoring local safety-net providers: do they have adequate capacity?Suzanne Felt-Lisk
Mathematica Policy Research, Washington, DC, USA
Health Aff (Millwood) 21:277-83. 2002..Also, free clinics grew during the 1990s, while many other safety-net providers focused on improving their efficiency and collecting more fees from patients...
- A review of HEDIS measures and performance for mental disordersBenjamin G Druss
Rollins School of Public Health, Emory University, Atlanta, USA
Manag Care 13:48-51. 2004..A critical step toward improving performance is to understand where care is provided and then to identify clinicians who are responsible for ensuring that care is delivered appropriately...
- Urologists on a tightrope--do we have a net?Kevin R Loughlin
Division of Urology, Brigham and Women s Hospital, Harvard Medical School, Boston, Massachusetts, USA
J Urol 170:2173-80. 2003..The purpose of this review is to analyze the current health care environment and its impact on urological practice...
- Promising practices: how leading safety-net plans are managing the care of Medicaid clientsMichael S Sparer
Mailman School of Public Health, Columbia University, USA
Health Aff (Millwood) 21:284-91. 2002..The evidence suggests that these are promising practices but that even these leaders still have a long way to go...
- The health insurance crisis in the United States: lack of access and the ripple effectMargaret Radzwill
Healthcare Management Consulting Services, Houston, USA
Manag Care Interface 16:28-34. 2003..The lack of access to proper care experienced by the uninsured also has a downstream effect on the insured population, threatening the quality of and access to health care for all Americans...
- Insights into problems obtaining care believed necessary as measured by the Medicaid Consumer Assessment of Health Plans Survey (CAHPS)Patricia J Venus
Center for Health Care Policy and Evaluation, Mail Stop MN002 260, 12125 Technology Drive, Eden Prairie, MN 55344, USA
Am J Manag Care 9:797-803. 2003..The Consumer Assessment of Health Plans Survey (CAHPS) is widely used to evaluate health plans; however there are few reports of Medicaid health plan efforts to improve performance as measured by CAHPS...
- The impact of Medicaid primary care case management on office-based physician supply in Alabama and GeorgiaE Kathleen Adams
Rollins School of Public Health, Emory University, USA
Inquiry 40:269-82. 2003....
- The sad history of health care cost containment as told in one chartDrew E Altman
Henry I. Kaiser Family Foundation, Menlo Park, California, USA
Health Aff (Millwood) . 2002
- The Nebraska Medicaid managed behavioral health care initiative: impacts on utilization, expenditures, and quality of care for mental healthEllen Bouchery
The Lewin Group, 3130 Fairview Park Drive, Suite 800, Falls Church, VA 22042, USA
J Behav Health Serv Res 30:93-108. 2003..Although a thorough assessment of quality of care impacts is warranted, this study suggests implementation of a managed care program may allow states to reduce Medicaid expenditures without compromising quality of care...
- Managed behavioral health care: an instrument to characterize critical elements of public sector programsM Susan Ridgely
RAND Health, Santa Monica, CA 90407-2138, USA
Health Serv Res 37:1105-23. 2002..CONCLUSIONS: If managed behavioral health care research is to advance beyond simple case study comparisons, a well-conceptualized set of instruments is necessary...
- Enrollee satisfaction with three Florida Medicaid managed care programsHsou Mei Hu
Health Services Research, Department of Health Services Administration, College of Health Professions, University of Florida, Gainesville, USA
Manag Care Interface 16:22-8. 2003..Improvements in satisfaction would require different interventions in each of the programs...
- Strategies to control costs and quality: a focus on outcomes research for disease managementVictor Villagra
Health and Technology Vector, Inc, Farmington, Connecticut 06032, USA
Med Care 42:III24-30. 2004..Theoretical work on a standard methodology that integrates clinical and financial outcomes and empiric validation is needed...
- Strategies for integrating Medicare and Medicaid: design features and incentivesEdward Alan Miller
University of Michigan, USA
Med Care Res Rev 60:123-57. 2003..Future efforts would be well served by carefully considering the incentive structures designed into these initiatives and working to improve them in the next generation of Medicare-Medicaid integration efforts...
- A study to assess patient satisfaction of transitioning from Medicaid to managed care by sickle cell patients in Hampton Roads, VirginiaJudy Anderson
Sickle Cell Association, Inc Norfolk, VA, USA
J Health Soc Policy 16:5-20. 2002....
- The effect of Medicaid managed care on mental health care for children: a review of the literatureAngela Blair Hutchinson
Joint PhD Program in Public Policy, Georgia State University and the Georgia Institute of Technology, Atlanta, Georgia, USA
Ment Health Serv Res 5:39-54. 2003..By reducing service use in inpatient settings, MMC has the potential to reduce children's mental health expenditures. The available research provides virtually no evidence on quality of care...
- QMHC interview. Interview with Thomas C. Shields, JDThomas C Shields
Qual Manag Health Care 12:191-5. 2003
- Coordinating services across the continuum of health, housing, and supportive servicesRobert Mollica
National Academy for State Health Policy, USA
J Aging Health 15:165-88. 2003..Several states are conducting demonstration programs that improve coordinating or integration of long-term care with the acute care system...
- Availability of nutrition services for Medicaid recipients in the northeastern United States: lack of uniformity and the positive effect of managed careAdam Gilden Tsai
Division of General Internal Medicine, 1125 Blockley Hall, University of Pennsylvania Medical Center, Philadelphia, PA 19104, USA
Am J Manag Care 9:817-21. 2003....
- Managed care market penetration, spillover effects, and the quality of cancer careJoseph Lipscomb
J Natl Cancer Inst 97:242-4. 2005
- Honesty as good policy: evaluating Maryland's Medicaid managed care programDebbie I Chang
Maryland State Department of Health and Mental Hygiene, MD, USA
Milbank Q 81:389-414. 2003
- Changes in county hospitals during Sheldon's tenureF William Blaisdell
University of California Davis School of Medicine, Sacramento, CA 95817, USA
Am J Surg 185:30-4. 2003..Sheldon's tenure, 1964 to 1985. The primary impact came from Medicaid and Medicare legislation in 1965. The secondary impact came as the result of the drug culture entering American cities...
- The Iowa Managed Substance Abuse Care Plan: access, utilization, and expenditures for Medicaid recipientsDennis McCarty
Department of Public Health and Preventive Medicine, CB669, Oregon Health and Science University, 3181 SW Sam Jackson Park Road, Portland, OR 97201, USA
J Behav Health Serv Res 30:18-25. 2003..Direct care costs decreased, while total expenditures held steady. The Iowa experience suggests that a well-planned initiative can control costs and improve access and utilization...
- Poor program's progress: the unanticipated politics of Medicaid policyLawrence D Brown
Department of Health Policy and Management, Joseph L Mailman School of Public Health, Columbia University, USA
Health Aff (Millwood) 22:31-44. 2003..That Medicaid has fared better than a "poor people's program" supposedly could has provocative implications for health reform debates...
- Do commercial managed care members rate their health plans differently than Medicaid managed care members?Patrick J Roohan
Bureau of Quality Management and Outcomes Research, Office of Managed Care, New York State Department of Health, Albany 12237, USA
Health Serv Res 38:1121-34. 2003..To determine if members of commercial managed care and Medicaid managed care rate the experience with their health plans differently...
- Has Medicaid managed care affected beneficiary access and use?Stephen Zuckerman
Health Policy Center, Urban Institute, Washington, DC 20037, USA
Inquiry 39:221-42. 2002..With the exception of mandatory HMO programs, discrepancies in access and use continue to exist between Medicaid managed care enrollees and low-income privately insured people...
- Plan characteristics and SSI enrollees' access to and quality of care in four TennCare MCOsSteven C Hill
Center for Cost and Financing Studies, Agency for Healthcare Research and Quality, Rockville, MD 20852, USA
Health Serv Res 37:1197-220. 2002....
- Medicaid managed care and racial differences in satisfaction and accessGreg Greenberg
University of North Carolina at Charlotte, USA
J Health Care Poor Underserved 14:351-71. 2003..In addition, race was not found to be associated with satisfaction. However, a Medicaid recipient's race was found to negatively affect his or her access to service under both managed care and fee-for-service systems...
- Satisfaction with quality and access to health care among people with disabling conditionsLisa I Iezzoni
Department of Medicine, Harvard Medical School, Beth Israel Deaconess Medical Center, Boston, MA 02215, USA
Int J Qual Health Care 14:369-81. 2002..To compare satisfaction with health care between persons with and without disabling conditions...
- Identifying areas for improvement: results of a Medicaid managed care diabetes surveyBeverly Pasley
New York State Department of Health, Office of Managed Care, Albany 12237, USA
J Health Care Poor Underserved 16:691-719. 2005..The results of this study will be used to propose interventions that Medicaid managed care plans can initiate to improve satisfaction of enrollees with diabetes...
- Payment for performance: in sickness and in health. For better or for worse?Richard S Goldman
Renal Medicine Associates, Albuquerque, NM 87106, USA goldmanrenalmed com
Blood Purif 24:28-32. 2006..Thus, we need to study how CPGs interact with one another in specific patient populations. The updating process for CPGs should include evidence-based statements concerning their impact on real patients with multiple chronic illnesses...
- Medicare and Medicaid managed care: a tale of two trajectoriesRobert E Hurley
Department of Health Administration REH, Virginia Commonwealth University, Richmond, USA
Am J Manag Care 12:40-4. 2006..It is useful for plan administrators to consider why the trajectories for the programs have been so divergent and to assess prospects for success in the Medicare Advantage initiative...
- A rural crossroadRichard Haugh
Hosp Health Netw 79:48-50, 52, 2. 2005..Some observers fear changes could be proposed that would weaken the CAH program...
- Relationship between quality of care and racial disparities in Medicare health plansAmal N Trivedi
Department of Community Health, Brown University, Providence, RI, USA
JAMA 296:1998-2004. 2006..Therefore, plan-specific performance reports of racial disparities on outcome measures would provide useful information not currently conveyed by standard HEDIS reports...
- Managed Care Penetration and Cancer CareEdward Guadagnoli; Fiscal Year: 2002..If managed care penetration is negatively associated with the delivery of care, interventions targeted toward policy-makers, providers, and patients will be needed to counteract the effects of market forces. ..
- Managed Care Penetration and Cancer CareNancy Keating; Fiscal Year: 2003..If managed care penetration is negatively associated with the delivery of care, interventions targeted toward policy-makers, providers, and patients will be needed to counteract the effects of market forces. ..
- Medicaid Managed Care for MH Services in Rural SettingsCathleen Willging; Fiscal Year: 2003....
- Obesity Prevention Tailored for Health IIKIM DANIEL REYNOLDS; Fiscal Year: 2010..Two 24-hour recalls will be completed at each assessment period. BMI and physical activity will be objectively measured through height and weight assessments, and through the use of accelerometry to assess physical activity. ..
- REGIONALIZATION, MARKET FORCES, AND NEONATAL MORTALITYCiaran Phibbs; Fiscal Year: 2003..abstract_text> ..
- PATTERNS AND OUTCOMES OF CARE FOR MEDICAID MENTALLY ILLDonald Steinwachs; Fiscal Year: 2001..This project will be undertaken in collaboration with the Maryland Department of Health and Mental Hygiene. ..
- ECONOMICS OF MANAGED BEHAVIORAL HEALTH CARERichard Scheffler; Fiscal Year: 2004..The first project proposed here, in particular, lays out that challenge. ..
- MEASURING PATIENT SATISFACTION: LOW LITERACY POPULATIONSJudy Shea; Fiscal Year: 2001..Finally, we will randomize eligible enrollees to receive the standard form or one of the alternative versions, to determine how the instruments perform in the typical way in which they would be used. ..
- RURAL RESPONSE TO MEDICARE+CHOICE: CHANGE AND ITS IMPACTKeith Mueller; Fiscal Year: 2001..Results of this study will be shared annually with the policy community and others through the publication series of the Rural Policy Research Institute. ..
- Medicaid Managed Care & Access to Alcohol TreatmentBentson McFarland; Fiscal Year: 2004..The investigators will explore application of hierarchical models and latent variable growth curves to the national data sets. The results will be of considerable interest to state Medicaid and alcohol drug abuse program directors. ..
- Older Adults and Specialty Care Use in Managed CareMaureen Smith; Fiscal Year: 2002..The proposed research will provide valuable information to clinicians, policymakers and researchers interested in the effects of managed care and health care providers (i.e., hospitals) on acutely-ill older patients. ..
- State Mental Health Policy-Making under Managed CareChristopher Erb; Fiscal Year: 2007..abstract_text> ..