managed care programs

Summary

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.

Top Publications

  1. ncbi 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
  2. pmc Identifying and characterizing COPD patients in US managed care. A retrospective, cross-sectional analysis of administrative claims data
    Douglas W Mapel
    Lovelace Clinic Foundation, Albuquerque, NM, USA
    BMC Health Serv Res 11:43. 2011
  3. pmc Patients' trust in physicians: many theories, few measures, and little data
    S 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
  4. doi Prevalence and cost of medication nonadherence in Parkinson's disease: evidence from administrative claims data
    Keith L Davis
    Health Economics, RTI Health Solutions, Research Triangle Park, North Carolina 27709, USA
    Mov Disord 25:474-80. 2010
  5. ncbi Predictors of adherence with antihypertensive and lipid-lowering therapy
    Richard H Chapman
    ValueMedics Research, LLC, Arlington, VA, USA
    Arch Intern Med 165:1147-52. 2005
  6. pmc Use of health information technology to improve medication adherence
    William M Vollmer
    Center for Health Research, 3800 N Interstate Ave, Portland, OR 97227 1110, USA
    Am J Manag Care 17:SP79-87. 2011
  7. pmc Assessing treatment effects of inhaled corticosteroids on medical expenses and exacerbations among COPD patients: longitudinal analysis of managed care claims
    Manabu Akazawa
    Department of Health Policy and Administration, University of North Carolina at Chapel Hill, CB 7411, Chapel Hill, NC 27599 7411, USA
    Health Serv Res 43:2164-82. 2008
  8. ncbi Practice patterns for managing Helicobacter pylori infection and upper gastrointestinal symptoms
    Colin W Howden
    Center for Health Economics and Policy, United BioSource Corporation, 7101 Wisconsin Ave, Ste 600, Bethesda, MD 20814, USA
    Am J Manag Care 13:37-44. 2007
  9. pmc Undertreatment of COPD: a retrospective analysis of US managed care and Medicare patients
    Barry Make
    National Jewish Health, Denver, CO, USA
    Int J Chron Obstruct Pulmon Dis 7:1-9. 2012
  10. ncbi Gout medication treatment patterns and adherence to standards of care from a managed care perspective
    Chaitanya A Sarawate
    Health Outcomes Research, HealthCore, Inc, 800 Delaware Ave, Fifth Floor, Wilmington, DE 19801 1366, USA
    Mayo Clin Proc 81:925-34. 2006

Research Grants

  1. Managed Care Penetration and Cancer Care
    Nancy Keating; Fiscal Year: 2003
  2. Managed Care Penetration and Cancer Care
    Edward Guadagnoli; Fiscal Year: 2002
  3. Medicaid Managed Care for MH Services in Rural Settings
    Cathleen Willging; Fiscal Year: 2003
  4. Obesity Prevention Tailored for Health II
    KIM DANIEL REYNOLDS; Fiscal Year: 2010
  5. REGIONALIZATION, MARKET FORCES, AND NEONATAL MORTALITY
    Ciaran Phibbs; Fiscal Year: 2003
  6. PATTERNS AND OUTCOMES OF CARE FOR MEDICAID MENTALLY ILL
    Donald Steinwachs; Fiscal Year: 2001
  7. ECONOMICS OF MANAGED BEHAVIORAL HEALTH CARE
    Richard Scheffler; Fiscal Year: 2004
  8. MEASURING PATIENT SATISFACTION: LOW LITERACY POPULATIONS
    Judy Shea; Fiscal Year: 2001
  9. RURAL RESPONSE TO MEDICARE+CHOICE: CHANGE AND ITS IMPACT
    Keith Mueller; Fiscal Year: 2001
  10. Medicaid Managed Care & Access to Alcohol Treatment
    Bentson McFarland; Fiscal Year: 2004

Detail Information

Publications309 found, 100 shown here

  1. ncbi 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...
  2. pmc Identifying and characterizing COPD patients in US managed care. A retrospective, cross-sectional analysis of administrative claims data
    Douglas W Mapel
    Lovelace Clinic Foundation, Albuquerque, NM, USA
    BMC Health Serv Res 11:43. 2011
    ..In anticipation of the increasing burden imposed on healthcare systems and payers by patients with COPD, a means of identifying COPD patients who incur higher healthcare utilization and costs is needed...
  3. pmc Patients' trust in physicians: many theories, few measures, and little data
    S 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...
  4. doi Prevalence and cost of medication nonadherence in Parkinson's disease: evidence from administrative claims data
    Keith L Davis
    Health Economics, RTI Health Solutions, Research Triangle Park, North Carolina 27709, USA
    Mov Disord 25:474-80. 2010
    ..Efforts to promote medication adherence in PD may lead to cost savings for managed care systems...
  5. ncbi Predictors of adherence with antihypertensive and lipid-lowering therapy
    Richard 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...
  6. pmc Use of health information technology to improve medication adherence
    William M Vollmer
    Center for Health Research, 3800 N Interstate Ave, Portland, OR 97227 1110, USA
    Am J Manag Care 17:SP79-87. 2011
    ..Study..
  7. pmc Assessing treatment effects of inhaled corticosteroids on medical expenses and exacerbations among COPD patients: longitudinal analysis of managed care claims
    Manabu Akazawa
    Department of Health Policy and Administration, University of North Carolina at Chapel Hill, CB 7411, Chapel Hill, NC 27599 7411, USA
    Health Serv Res 43:2164-82. 2008
    ..To assess costs, effectiveness, and cost-effectiveness of inhaled corticosteroids (ICS) augmenting bronchodilator treatment for chronic obstructive pulmonary disease (COPD)...
  8. ncbi Practice patterns for managing Helicobacter pylori infection and upper gastrointestinal symptoms
    Colin W Howden
    Center for Health Economics and Policy, United BioSource Corporation, 7101 Wisconsin Ave, Ste 600, Bethesda, MD 20814, USA
    Am J Manag Care 13:37-44. 2007
    ..To assess adherence with guidelines for testing and treatment of Helicobacter pylori infection and upper gastrointestinal symptoms...
  9. pmc Undertreatment of COPD: a retrospective analysis of US managed care and Medicare patients
    Barry Make
    National Jewish Health, Denver, CO, USA
    Int J Chron Obstruct Pulmon Dis 7:1-9. 2012
    ..We investigated a large population of patients with chronic obstructive pulmonary disease (COPD) to determine their frequency of medication use and patterns of pharmacotherapy...
  10. ncbi Gout medication treatment patterns and adherence to standards of care from a managed care perspective
    Chaitanya 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...
  11. pmc The influence of gatekeeping and utilization review on patient satisfaction
    E A Kerr
    Center for Practice Management and Outcomes Research, VA Medical Center, Ann Arbor, Mich, USA
    J Gen Intern Med 14:287-96. 1999
    ..Health plans and physician groups need to take these factors into account when designing strategies to reduce specialty care use...
  12. pmc Getting more for their dollar: a comparison of the NHS with California's Kaiser Permanente
    Richard G A Feachem
    Institute for Global Health, University of California, San Francisco, 94105, USA
    BMJ 324:135-41. 2002
    ..To compare the costs and performance of the NHS with those of an integrated system for financing and delivery health services (Kaiser Permanente) in California...
  13. ncbi The role of health plans in tobacco control
    Marc 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...
  14. ncbi Effects of a prior-authorization policy for celecoxib on medical service and prescription drug use in a managed care Medicaid population
    Daniel M Hartung
    Oregon State University College of Pharmacy, Portland, USA
    Clin Ther 26:1518-32. 2004
    ..Prior authorization (PA) is a poorly studied but commonly employed policy used by health care payers to manage the rising costs of pharmacy benefits...
  15. ncbi Use and impact of an automated telephone outreach system for asthma in a managed care setting
    William M Vollmer
    Center for Health Research, Kaiser Permanente Northwest, Portland, OR 97227, USA
    Am J Manag Care 12:725-33. 2006
    ..To test the ability of an automated telephone outreach intervention to reduce acute healthcare utilization and improve quality of life among adult asthma patients in a large managed care organization...
  16. pmc The impact of Medicaid managed care on hospitalizations for ambulatory care sensitive conditions
    Andrew B Bindman
    Primary Care Research Center, University of California, San Francisco, San Francisco, CA 94143 1364, USA
    Health Serv Res 40:19-38. 2005
    ..We also explored whether there was a differential effect of Medicaid managed care by patient's race or ethnicity on the hospitalization rates for ambulatory care sensitive conditions...
  17. ncbi Tobacco-control policies in 11 leading managed care organizations: progress and challenges
    Nancy 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...
  18. ncbi Outcomes and lessons learned from evaluating TRICARE's disease management programs
    Timothy 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...
  19. ncbi Implementation of evidence-based tobacco use cessation guidelines in managed care organizations
    C Barr Taylor
    Department of Psychiatry, Stanford University School of Medicine, CA, USA
    Ann Behav Med 27:13-21. 2004
    ..Although managed care organizations (MCOs) may be optimal settings for implementing tobacco use cessation clinical guidelines, such guidelines remain poorly implemented in many MCO settings...
  20. ncbi The impact of managed health care in the United States on women with breast cancer and the providers who treat them
    Joretha 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...
  21. ncbi Health outcomes. New quality measure for Medicare
    J 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...
  22. pmc Functional health outcomes as a measure of health care quality for Medicare beneficiaries
    A 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...
  23. ncbi The financial implications of coverage of smoking cessation treatment by managed care organizations
    Kenneth 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...
  24. pmc Health behaviors and quality of care among Latinos with diabetes in managed care
    Arleen 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...
  25. pmc Addressing tobacco in managed care: results of the 2003 survey
    Carol 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...
  26. ncbi Quality information and consumer health plan choices
    Nancy 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...
  27. ncbi Two-year effects of quality improvement programs on medication management for depression
    J Unutzer
    Center for Health Services Research, Neuropsychiatric Institute, University of California, Los Angeles, 10920 Wilshire Blvd, Suite 300, Los Angeles, CA 90024, USA
    Arch Gen Psychiatry 58:935-42. 2001
    ..Significant underuse of evidence-based treatments for depression persists in primary care. We examined the effects of 2 primary care-based quality improvement (QI) programs on medication management for depression...
  28. pmc Why don't diabetes patients achieve recommended risk factor targets? Poor adherence versus lack of treatment intensification
    Julie A Schmittdiel
    Division of Research, Kaiser Permanente Medical Care Program, Oakland, CA, USA
    J Gen Intern Med 23:588-94. 2008
    ..Despite the availability of effective hypertension, hyperlipidemia, and hyperglycemia therapies, target levels of systolic blood pressure (SBP), LDL-cholesterol (LDL-c), and hemoglobin A1c control are often not achieved...
  29. ncbi The commercial health insurance industry in an era of eroding employer coverage
    James 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...
  30. ncbi Impact of rosuvastatin use on costs and outcomes in patients at high risk for cardiovascular disease in US managed care and medicare populations: A data analysis
    Daniel M Huse
    Thomson Medstat, Ann Arbor, Michigan, USA
    Clin Ther 28:1425-42. 2006
    ..High blood cholesterol is a major modifiable risk factor for coronary heart disease (CHD) and stroke...
  31. doi Direct medical costs for type 2 diabetes mellitus complications in the US commercial payer setting: a resource for economic research
    Elise M Pelletier
    IMS Consulting Services, Watertown, Massachusetts, USA
    Appl Health Econ Health Policy 6:103-12. 2008
    ..However, the published literature shows great variability across studies in the number and type of sources from which these costs for diabetes are obtained...
  32. doi Disease management 360 degrees: a scorecard approach to evaluating TRICARE's programs for asthma, congestive heart failure, and diabetes
    Wenya 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...
  33. pmc Incremental cardiovascular costs and resource use associated with diabetes: an assessment of 29,863 patients in the US managed-care setting
    Robert J Straka
    Department of Experimental and Clinical Pharmacology, University of Minnesota College of Pharmacy, Minneapolis, MN, USA
    Cardiovasc Diabetol 8:53. 2009
    ..We conducted a retrospective claims database analysis to evaluate incremental cardiovascular costs in diabetic versus non-diabetic patients hospitalized for a cardiovascular event...
  34. ncbi 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
    ....
  35. ncbi Pharmacoeconomic evaluation of a pharmacist-managed hypertension clinic
    M 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...
  36. pmc Impact of 3-tier formularies on drug treatment of attention-deficit/hyperactivity disorder in children
    Haiden 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...
  37. ncbi Changing medication use in managed care: a critical review of the available evidence
    Sallie 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
    ..To review the effectiveness of strategies to improve the quality and efficiency of medication use in managed care organizations (MCOs)...
  38. ncbi Receipt of asthma subspecialty care by children in a managed care organization
    Michael 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...
  39. ncbi Occurrence of secondary ischemic events among persons with atherosclerotic vascular disease
    Barbara 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...
  40. ncbi 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
    ....
  41. pmc Managed care, access to specialists, and outcomes among primary care patients with pain
    David 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
    ..To determine whether managed care controls were associated with reduced access to specialists and worse outcomes among primary care patients with pain...
  42. ncbi 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 disease
    James 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
    ....
  43. ncbi Changes in antibiotic prescribing for children after a community-wide campaign
    Joseph F Perz
    Epidemic Intelligence Service, Epidemiology Program Office, Centers for Disease Control and Prevention, Atlanta, GA, USA
    JAMA 287:3103-9. 2002
    ..Very high levels (>50%) of antibiotic resistance among invasive Streptococcus pneumoniae have been documented in Knox County, Tennessee...
  44. pmc Effects of Medicaid managed care programs on health services access and use
    Bowen Garrett
    The Urban Institute, Health Policy Center, Washington, DC 20037, USA
    Health Serv Res 38:575-94. 2003
    ..To estimate the effects of Medicaid managed care (MMC) programs on Medicaid enrollees' access to and use of health care services at the national level...
  45. ncbi Managed care and the US health care system a social exchange perspective
    David 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...
  46. pmc Managed care, access to mental health specialists, and outcomes among primary care patients with depressive symptoms
    David 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...
  47. ncbi Validation of data collection for the HEDIS performance measure on chlamydia screening in an MCO
    Feifei 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)...
  48. ncbi Quality of care for secondary prevention for patients with coronary heart disease: results of the Hastening the Effective Application of Research through Technology (HEART) trial
    David 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
    ....
  49. ncbi 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 Study
    Paula 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...
  50. ncbi Serum urate levels and gout flares: analysis from managed care data
    Chaitanya 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...
  51. ncbi Evaluation of laboratory monitoring alerts within a computerized physician order entry system for medication orders
    Ted 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...
  52. ncbi Impact of a managed-Medicare physical activity benefit on health care utilization and costs in older adults with diabetes
    Huong 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...
  53. doi Adherence with multiple-combination antihypertensive pharmacotherapies in a US managed care database
    Kenneth C Jackson
    Clin Ther 30:1558-63. 2008
    ..The aim of this analysis was to assess the impact of multiple combination therapies on medication possession ratios (MPRs) in an antihypertensive naive population...
  54. ncbi Descriptive analysis of the direct medical costs of multiple sclerosis in 2004 using administrative claims in a large nationwide database
    Jeff 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...
  55. ncbi Impact of disease management on health care utilization: evidence from the "Florida: A Healthy State (FAHS)" Medicaid Program
    Abdelmonem 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...
  56. pmc Revisiting the relationship between managed care and hospital consolidation
    Robert 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...
  57. ncbi Improving asthma management: one health plan's experience
    Andrew 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...
  58. ncbi Validity of the Asthma Control Test completed at home
    Michael 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...
  59. ncbi Physicians' perceptions of managed care: a review of the literature
    Jon 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...
  60. pmc 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
  61. ncbi Inequality of access to surgical specialty health care: why children with government-funded insurance have less access than those with private insurance in Southern California
    Edward C Wang
    Department of Otolaryngology, Keck School of Medicine, University of Southern California, Los Angeles, California, USA
    Pediatrics 114:e584-90. 2004
    ....
  62. ncbi 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...
  63. ncbi Use of geocoding in managed care settings to identify quality disparities
    Allen M Fremont
    RAND Health, Santa Monica, California, USA
    Health Aff (Millwood) 24:516-26. 2005
    ....
  64. ncbi Failure of Internet-based audit and feedback to improve quality of care delivered by primary care residents
    Steven 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...
  65. ncbi Achieving cholesterol target in a managed care organization (ACTION) trial
    Robert J Straka
    Department of Experimental and Clinical Pharmacology, College of Pharmacy, University of Minnesota, Minneapolis, Minnesota 55455, USA
    Pharmacotherapy 25:360-71. 2005
    ....
  66. ncbi Managed care organization characteristics and outpatient specialty care use among children with chronic illness
    Elizabeth 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...
  67. ncbi 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...
  68. ncbi Plan choice and changes in access to care over time for SSI-eligible children with disabilities
    Pamela 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...
  69. ncbi Optimal design features for surveying low-income populations
    Doren 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...
  70. doi Association between prescription burden and medication adherence in patients initiating antihypertensive and lipid-lowering therapy
    Joshua 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...
  71. pmc Methadone maintenance and state Medicaid managed care programs
    D McCarty
    Brandeis University, USA
    Milbank Q 77:341-62, 274. 1999
    ....
  72. ncbi Satisfaction with services in innovative managed care programs for groups of traditionally underserved individuals with HIV/AIDS: empirical models
    D 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...
  73. pmc The impact of managed care on children's access, satisfaction, use, and quality of care
    P 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...
  74. ncbi Switching to gatekeeping: changes in expenditures and utilization for children
    T 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...
  75. ncbi Impact of the Oregon Health Plan on children with special health care needs
    J 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...
  76. ncbi Managed care, consolidation among health care providers, and health care: evidence from mammography
    L 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...
  77. ncbi Management of multiple sclerosis across managed care and fee-for-service systems
    B 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...
  78. pmc Managed care, professional autonomy, and income: effects on physician career satisfaction
    J 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...
  79. ncbi A benefit-based copay for prescription drugs: patient contribution based on total benefits, not drug acquisition cost
    A 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...
  80. ncbi Effects of Medicaid managed care on health care use: infant emergency department and ambulatory services
    E 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...
  81. ncbi A study to assess patient satisfaction of transitioning from Medicaid to managed care by sickle cell patients in Hampton Roads, Virginia
    Judy Anderson
    Sickle Cell Association, Inc Norfolk, VA, USA
    J Health Soc Policy 16:5-20. 2002
    ....
  82. pmc 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...
  83. ncbi Medicaid managed care and racial differences in satisfaction and access
    Greg 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...
  84. ncbi Relationship between quality of care and racial disparities in Medicare health plans
    Amal N Trivedi
    Department of Community Health, Brown University, Providence, RI, USA
    JAMA 296:1998-2004. 2006
    ..In the Medicare managed care program, broad improvements in quality have been accompanied by reduced racial gaps in processes of care, but substantial disparities in outcomes have persisted...
  85. ncbi QMHC interview. Interview with Thomas C. Shields, JD
    Thomas C Shields
    Qual Manag Health Care 12:191-5. 2003
  86. pmc Honesty as good policy: evaluating Maryland's Medicaid managed care program
    Debbie I Chang
    Maryland State Department of Health and Mental Hygiene, MD, USA
    Milbank Q 81:389-414. 2003
  87. ncbi Strategies for integrating Medicare and Medicaid: design features and incentives
    Edward 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...
  88. ncbi Enrollee satisfaction with three Florida Medicaid managed care programs
    Hsou 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...
  89. ncbi Coordinating services across the continuum of health, housing, and supportive services
    Robert 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...
  90. ncbi The Iowa Managed Substance Abuse Care Plan: access, utilization, and expenditures for Medicaid recipients
    Dennis 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...
  91. ncbi The Nebraska Medicaid managed behavioral health care initiative: impacts on utilization, expenditures, and quality of care for mental health
    Ellen 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...
  92. ncbi Law, medicine, and wealth: does concierge medicine promote health care choice, or is it a barrier to access?
    Sandra J Carnahan
    South Texas College of Law, USA
    Stanford Law Pol Rev 17:121-63. 2006
  93. ncbi The sad history of health care cost containment as told in one chart
    Drew E Altman
    Henry I Kaiser Family Foundation, Menlo Park, California, USA
    Health Aff (Millwood) . 2002
  94. ncbi Commercial health insurance: smart or simply lucky?
    Marsha Gold
    Mathematica Policy Research in Washington, DC, USA
    Health Aff (Millwood) 25:1490-3. 2006
    ..Unfortunately, unless the drivers of health care cost are tamed, the main benefits that people seek from insurance-stable coverage and financial protection--will erode further...
  95. ncbi Length of stay at an all-time low
    Renee 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...
  96. ncbi A rural crossroad
    Richard Haugh
    Hosp Health Netw 79:48-50, 52, 2. 2005
    ..Some observers fear changes could be proposed that would weaken the CAH program...
  97. ncbi 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...
  98. ncbi Private insurance and the utilization of chemical dependency treatment
    Laura 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...
  99. ncbi Maximizing reimbursement from trauma response fees (UB-92: 68X) - lessons learned from a hospital comparison
    John B Fortune
    Southern Illinois Trauma Center, Springfield, Illinois, USA
    J Trauma 58:482-6. 2005
    ..This study compares two trauma centers' performance in collecting this fee help define methodologies that can enhance reimbursement...
  100. ncbi A review of HEDIS measures and performance for mental disorders
    Benjamin 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...
  101. ncbi The effect of Medicaid managed care on mental health care for children: a review of the literature
    Angela 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...

Research Grants75

  1. Managed Care Penetration and Cancer Care
    Nancy 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. ..
  2. Managed Care Penetration and Cancer Care
    Edward 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. ..
  3. Medicaid Managed Care for MH Services in Rural Settings
    Cathleen Willging; Fiscal Year: 2003
    ....
  4. Obesity Prevention Tailored for Health II
    KIM 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. ..
  5. REGIONALIZATION, MARKET FORCES, AND NEONATAL MORTALITY
    Ciaran Phibbs; Fiscal Year: 2003
    ..abstract_text> ..
  6. PATTERNS AND OUTCOMES OF CARE FOR MEDICAID MENTALLY ILL
    Donald Steinwachs; Fiscal Year: 2001
    ..This project will be undertaken in collaboration with the Maryland Department of Health and Mental Hygiene. ..
  7. ECONOMICS OF MANAGED BEHAVIORAL HEALTH CARE
    Richard Scheffler; Fiscal Year: 2004
    ..The first project proposed here, in particular, lays out that challenge. ..
  8. MEASURING PATIENT SATISFACTION: LOW LITERACY POPULATIONS
    Judy 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. ..
  9. RURAL RESPONSE TO MEDICARE+CHOICE: CHANGE AND ITS IMPACT
    Keith 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. ..
  10. Medicaid Managed Care & Access to Alcohol Treatment
    Bentson 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. ..
  11. Older Adults and Specialty Care Use in Managed Care
    Maureen 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. ..
  12. State Mental Health Policy-Making under Managed Care
    Christopher Erb; Fiscal Year: 2007
    ..abstract_text> ..