Biomedical subjects

J Eisenhandler

Publications and source records attributed to J Eisenhandler.

4 recordsLinked to original sources

PubMed1999

The prospective risk adjustment system.

The Episode Classification System is intended to perform two tasks. First, it will be a prospective capitation risk adjuster and predict future health care costs. It will do this by assigning each individual a single capitation risk adjustment category based on an analysis of the medical history and of health care services rendered during a specific period of time. Second, the Episode Classification System will create retrospective severity adjusted Episodes of illness or Episodes of Care. These latter Episodes will provide a framework for relating patient characteristics to the amount, type, and duration of services provided during the treatment of a specific disease. These Episodes will give users the ability to understand past costs and the risk of mortality. As such they will form the basis for provider profiling by allowing users to analyze a complete clinical episode.

Actuarial Analysis↗

PubMed1993

Opiate dependency among the subscribers of a New York area private insurance plan.

OBJECTIVE: To estimate the prevalence of opiate use among the subscribers of a large private insurance plan, Empire Blue Cross and Blue Shield (EBCBS). DESIGN: Six and a half million hospital inpatient claims for the period January 1, 1982, through June 30, 1992, were reviewed. Thirty-one thousand eight hundred ten different individuals who had a total of 55,143 hospital admissions with a primary diagnosis of opiate dependency (International Classification of Diseases, Ninth Revision, Clinical Modification 304.0 and 304.7) were identified. In the same period, 17,493 EBCBS subscribers (15,191 male and 2302 female) were identified from hospital admissions data as having acquired immunodeficiency syndrome. These data were cross-matched with the opiate dependency data to estimate the "capture" of opiate users in the EBCBS subscribers with acquired immunodeficiency syndrome and to model the size of the opiate using population in EBCBS. RESULTS: It is estimated that between 1982 and 1992 EBCBS insured approximately 141,000 opiate users, 85,000 of whom are currently insured by EBCBS. CONCLUSION: There is a large population of insured opiate users who may be excluded from the estimates of the overall number of opiate users as insured opiate users are less likely to be counted via contact with government agencies. This suggests that current estimates of the number of opiate users and their social characteristics should be reconsidered.

Acquired Immunodeficiency Syndrome↗

PubMedDate not supplied

Satisfaction with home healthcare services for clients with HIV: preliminary findings.

The Visiting Nurse Service of New York and Empire Blue Cross and Blue Shield implemented in 1990 the "At Home Options Program" (AHOP), an enhanced package of home care and other noninpatient services for HIV-positive clients. AHOP aims to reduce total treatment costs and hospital days. Clients (N = 52) completed mailed satisfaction surveys. Overall, clients were very satisfied with AHOP services. Clients expressed concerns, however, about the uneven quality of substitute paraprofessionals, and said they needed easier access to a knowledgeable healthcare professional. Operational concerns included inadequate information dissemination and administrative oversights. Findings will inform subsequent program activities.

Adult↗

PubMedDate not supplied

Payment and provider profiling of episodes of illness of clinical illnesses involving rehabilitation.

The prevailing trend in American health care finance for the last two decades and likely for the forseeable future, is the movement from a system based on fee for service payments to one dominated by capitation arragements. At the core of this change is a shifting of risk from payers to providers. Such a fundamental transition is not without its difficulties. This is exemplified by some of the problems experienced by the Health Care Financing Administration (HCFA) as it has begun to encourage beneficiaries to move from traditional fee for service Medicare to capitated HMOs. The most recently published regulations involving risk adjustment of rates of payment for managed care organizations (MCOs) did not find much favor as the statistical power was poor and the clinical meaningfulness of the risk adjustment was highly problematic. Specifically, the risk adjustment explained less than 10% of the variation in costs (compared to approximately 30% when DRGs were first implemented). From a clinical perspective, the methodology only used hospitalization data for adjustment of capitation rates; that is, anyone who was not hospitalized was assumed to be healthy! It is known that payment for rehabilitation services is among the most difficult to understand and predict of all medical care. This article will summarize the development of a new risk adjustment methodology which should be particularly useful for payment and monitoring of episodes of clinical conditions that involve rehabilitation. The article will conclude with directions for future research.

Capitation Fee↗