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Biomedical subjects

R K Spoeri

Publications and source records attributed to R K Spoeri.

14 recordsLinked to original sources
PubMed1999

Polypharmacy management in Medicare managed care: changes in prescribing by primary care physicians resulting from a program promoting medication reviews.

OBJECTIVE: To examine the effects of medication reviews by primary care physicians on prescriptions written for elderly members of a Medicare managed care organization who were at risk for polypharmacy. STUDY DESIGN: Prospective study with follow-up survey. PATIENTS AND METHODS: We conducted a study in 1995 to demonstrate the prevalence of polypharmacy (defined as receiving 5 or more prescription medications during the 3-month study period) among elderly members of our managed care organization. Two years later, elderly members identified as being at risk for polypharmacy were sent a letter encouraging them to schedule a medication review with their primary care physician. Each primary care physician was provided with clinical practice guidelines on polypharmacy and patient-specific medication management reports. Patients and physicians were subsequently mailed a survey to assess the impact of the medication review program on prescribing practices. RESULTS: Of 37,372 elderly members screened, 5737 (15%) were at risk for polypharmacy. Of these, 2615 (46%) responded to the follow-up survey. Of the survey respondents, 1087 (42%) had gone to their primary care physician for a medication review. During the review, 96% of patients discussed their prescription medications and 72% discussed nonprescription medications they were taking. Twenty percent reported that their physician discontinued medications, 29% reported that the physician changed the dose of a medication, and 17% informed their physician about a new prescription or nonprescription medication they were taking. Of the 275 primary care physicians surveyed, 56 (20%) returned the questionnaire. Of these, 61% reported that the medication review program was "very" or "somewhat useful." Thirty-five percent reported discontinuing unnecessary medications, and 23% reported decreasing the frequency of dosing. Overall, 45% of physicians reported making at least one change in their prescribing to a member at risk for polypharmacy. CONCLUSIONS: Our program promoting medication reviews between primary care physicians and their elderly patients resulted in significant changes in prescribing by physicians. This type of program is likely to decrease the risk of polypharmacy among older members of a Medicare managed care organization.

Aged↗
PubMed1997

Measuring and reporting managed care performance: lessons learned and new initiatives.

Performance measurement has become increasingly popular in the health care delivery system of the United States. Until recently, the hospital was the most commonly scrutinized setting. With the expansion of managed care and the resulting compilation of large administrative databases, interest in performance measurement beyond the hospital setting has increased considerably. In particular, the performance of health maintenance organizations is now being assessed and reported publicly. The performance of individual physicians is also garnering considerable attention. This paper summarizes some of the many developments in performance measurement in managed care. The Health Plan Employer Data and Information Set (HEDIS) is described in the context of the national Report Card Pilot Project and with respect to local report card projects emerging around the United States. The lessons learned are identified, particularly with respect to external auditing of HEDIS data. Finally, the new initiatives of physician profiling and outcomes reporting are discussed.

Databases, Factual↗
PubMed1997

How does HEDIS affect quality improvement strategies in an HMO?

To meet the demands of the marketplace, health plans devote considerable resources to comply with Health Plan Employer Data and Information Set (HEDIS) reporting standards and to improve performance along those measures. Given HEDIS's growing prominence, one might question whether it plays a major role in the formulation of an HMO's quality improvement strategies. The experience at NYLCare Health Plans, Inc., suggests that quality improvement strategies should focus on strengthening the ability of HMOs to meet the more general agenda of quality measurement and improvement, and not just requirements specific to HEDIS.

Health Benefit Plans, Employee↗
PubMedDate not supplied

Satisfaction and choice: a view from the plans.

Community-wide surveys have demonstrated that managed care enrollees tend to express higher satisfaction with their health plan if they have been given the opportunity to make a choice between managed care and fee-for-service plans. This DataWatch shows similar results with plan-specific data, even for enrollees whose plan benefits include coverage for out-of-network services. That is, what matters seems to be choice at the time of enrollment, not at the point of service. Further, in the practical application of ranking plans on overall enrollee satisfaction, choice appears to be a more important influence than other factors that may receive attention, including enrollees' health status. We discuss this phenomenon with respect to competition and strategy in the managed care marketplace.

Choice Behavior↗
PubMedDate not supplied

Quality in managed care: developments and considerations.

With the rapid movement of both individuals and groups away from fee-for-service health care into managed care, concerns have been expressed appropriately that the quality of care may be affected adversely. Over the past several years, a number of developments have taken place to respond to these concerns. This quality movement in managed care has not been without some issues and considerations, however. This article first describes the National Committee for Quality Assurance (NCQA) and the prominent role it has played in this movement. Next, quality improvement study design is addressed in the context of assuring quality, controlling costs, and achieving NCQA accreditation. The effect that capitation, as a payment strategy for providers, has on data quality is then described. Fourth, the value of partnering is explored. Finally, the newest version of NCQA's performance measurement template is discussed: the Health Plan Employer Data and Information Set, version 3.0.

Accreditation↗