PubMed · 3959919
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K S Brown. 1986. Consider a simplified employee pension program.. https://pubmed.ncbi.nlm.nih.gov/3959919/
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Following the continuing expansion of managed care is a growing public interest in the quality of care provided by managed care organizations. Public and private organizations are actively developing systems for measuring and monitoring quality of care with the intention of holding plans more accountable for quality improvements and encouraging health care consumers to make responsible choices. This article examines correlations between a prevention-based quality measure and other commonly used measures of differentiating health plans, including financial performance and profit status. The findings are instructive in efforts to develop a quality measurement system that incorporates a variety of measures of plan performance.
Federal Section 1915(b) and Section 1115 waivers, through the Health Care Financing Administration, are the primary modes for implementing Medicaid-managed mental health and chemical dependency services. This paper focuses on three distinct case studies of managed mental health programs in Tennessee, Massachusetts, and Hawaii. The purpose is to determine, among other design factors (such as carve-in, carve-out, and covered services) the specific roles that differences in the financing structure play in the relative success of these programs. Findings from the three distinct models should provide lessons for the impending mental health programs of other states, including those in the varying stages of implementation.