PubMed · 17154108
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Ken Terry. 2006-11-03. Can an MSO help you?. https://pubmed.ncbi.nlm.nih.gov/17154108/
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OBJECTIVE: The objective of this study was to evaluate how enrollment in a partially capitated managed care (MC) option versus the fee-for-service (FFS) system affects caregivers' ratings of dimensions of access to services among children with special health care needs (SHCN). SUBJECTS: The data were collected from telephone interviews during the summer and fall of 2002 with a random sample of 1088 caregivers of children with SHCN who qualified for Supplemental Security Income and therefore were enrolled the Medicaid program for children with SHCN in the District of Columbia. RESEARCH DESIGN: We used a 2-step procedure in which we first estimated plan choice and then constructed a selectivity correction to control for the potential selection bias linked to plan choice. We estimated the second stage equations predicting caregiver's ratings of dimensions of access as a function of the selectivity correction, the plan choice dummy variable and other exogenous variables. RESULTS: After controlling for the potential selection bias linked to plan choice and other confounding factors, we find that caregivers of children in FFS are significantly more likely than caregivers of children enrolled in the partially capitated MC plan to rate the following dimensions of access as either fair or poor: "access to specialists' care" (P < 0.01), "access to emergency room care" (P < 0.01), "convenience of the doctor's office" (P < 0.01), and "waiting time between making the appointment actual visit" (P < 0.05). CONCLUSIONS: We attribute these differences in caregivers' ratings of dimensions of access that exist between partially capitated MC and FFS enrollees to case management and care coordination services along with higher fees paid for pediatrician's and specialists' services available under MC option.
High-deductible health plans--with and without spending accounts--are gaining ground. Will these evolving benefit designs complement or undermine the coordination of care for patients with chronic illnesses? Based on an October 2005 roundtable sponsored by the California HealthCare Foundation and Health Affairs, this paper discusses the implications of a changing health insurance market for the chronically ill, capitation payment for medical groups, and consumers navigating the system.
PURPOSE: Risk-adjustment is designed to predict healthcare costs to align capitated payments with an individual's expected healthcare costs. This can have the consequence of reducing overpayments and incentives to under treat or reject high cost individuals. This paper seeks to review recent studies presenting risk-adjustment models. DESIGN/METHODOLOGY/APPROACH: This paper presents a brief discussion of two commonly reported statistics used for evaluating the accuracy of risk adjustment models and concludes with recommendations for increasing the predictive accuracy and usefulness of risk-adjustment models in the context of predicting future healthcare costs. FINDINGS: Over the last decade, many advances in risk-adjustment methodology have been made. There has been a focus on the part of researchers to transition away from including only demographic data in their risk-adjustment models to incorporating patient data that are more predictive of healthcare costs. This transition has resulted in more accurate risk-adjustment models and models that can better identify high cost patients with chronic medical conditions. ORIGINALITY/VALUE: The paper shows that the transition has resulted in more accurate risk-adjustment models and models that can better identify high cost patients with chronic medical conditions.