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At least 541 records · Page 30Linked to original sources
PubMed1999

Depressive symptoms and plan switching under managed care.

OBJECTIVE: A central assumption underlying managed care is that plan switching is a viable option for enrollees when they are dissatisfied. The authors used a national employee survey to test the hypothesis that this mechanism is less effective for enrollees with high levels of depressive symptoms than for the remainder of the population. METHOD: The study used data from the Employee Health Care Value Survey, a 1993 survey of 20,283 employees of three major corporations. The authors used the Medical Outcomes Study 36-Item Short-Form Health Survey to identify individuals with the highest decile of depressive and physical symptoms. They examined the relationship between symptoms and dissatisfaction and, for dissatisfied individuals, how symptoms predicted plan switching. Multivariate models were used to control for potential demographic, health, and health coverage confounders. RESULTS: Depressive and physical symptoms were both associated with dissatisfaction with care. Unlike physical symptoms, depressive symptoms were associated with a significantly lower likelihood of actually disenrolling among people who were dissatisfied or who intended to disenroll. This effect was most pronounced for satisfaction with administrative aspects of care (e.g., gatekeeping, utilization review). CONCLUSIONS: People with high levels of depressive symptoms appeared to be less willing or able to act on their dissatisfaction by switching plans. In particular, they were willing to tolerate higher rates of dissatisfaction with the administrative aspects of their health coverage without disenrolling. Plan switching is an essential mechanism underpinning a health care system predicated on competition; it may be less effective for people with depressive disorders.

Attitude to Health↗
PubMed1996

Health care integration: the role of information technologies.

Information technologies are rapidly becoming the major process drivers of health care system integration. These integrated information systems will emanate from MCOs and pervade the entire health care system at each level of service delivery. Suggestions for facilitating the integration process and the role of pharmaceutical industry, wholesalers, service providers, and end users are discussed herein.

Computer Security↗
PubMed1996

Managed care in the pediatric subspecialty of neonatology. The challenges, impact, and consequences.

As our health care system moves toward a more managed competition model, the delivery of pediatric and pediatric specialists' services, especially the intensive and procedural services of neonatology, will be impacted. Pediatricians and pediatric subspecialists cannot avoid being buffeted from the powerful market forces that are now driving revolutionary changes in our health care system; they, like nonpediatric physicians, are often concerned and bewildered about the new realities of the day.

Female↗
PubMed2000

Ethics in managed care.

The current era of managed costs and care create ethical dilemmas based on economic constraints and incorporation of principles of distributive justice. Traditional ethical concerns related to confidentiality, conflicts of interest, double agentry, and honesty are complicated by interference in the doctor-patient relationship caused by intrusive utilization management. National health reform must take these issues seriously to ensure that the "cure" promised by such reform efforts is not worse than the disease. The challenge for psychiatrists is to adapt to these constraints without losing site of traditional medical ethical positions. Once the ethics become diseased, no cure may exist at all.

Adult↗
PubMed1993

Enhancing case management through computerized patient files.

The need for developing an organizational system for managing a large patient specialty population prompted the use of a computerized data entry and retrieval system. The use of a computerized system has facilitated patient case management, chart organization, and development of accessible data for research. Patient data fields (topic headings) are used for: (1) storing specific categories of patient data, (2) compiling lists for management and research, and (3) referring physician and patient/family contact information. Various lists can be compiled from the field data base in order to develop research and patient management lists. Patient management lists are used to track a patient's progress, provide quality assurance of care, and contribute researchable data. Also, patient information can be transferred automatically from the computerized daily management system into a computerized form letter. Individualized patient letters may be generated. Laboratory and test information from the last clinic or hospital visit can be mailed to families along with a handwritten personalized interpretation of their results by the CNS or physician.

Humans↗
PubMed1997

Managed care: how economic incentive reforms went wrong.

In its response to pressures to rationalize health care resource allocation, the American health care system has embraced managed care without concurrent comprehensive health care reform, either in the form of the centralized tax-based systems found in Europe and Canada or that of the Clinton reform plan. What survives is managed care without managed competition, employer mandates, or universal access. Two problems inherent in the incentive structure of managed care plans developed in the absence of comprehensive health care reform work against the public interest. First, sacrifices in terms of medical innovation and quality of care may not be offset by greater equity in the distribution of health care. Second, such managed care plans fail to address the need for long-term accountability.

Biomedical Technology↗
PubMed2001

Are urban safety-net hospitals losing low-risk Medicaid maternity patients?

OBJECTIVE: To examine data on Medicaid and self-pay/charity maternity cases to address four questions: (1) Did safety-net hospitals' share of Medicaid patients decline while their shares of self-pay/charity-care patients increased from 1991 to 1994? (2) Did Medicaid patients' propensity to use safety-net hospitals decline during 1991-94? (3) Did self-pay/charity patients' propensity to use safety-net hospitals increase during 1991-94? (4) Did the change in Medicaid patients' use of safety-net hospitals differ for low- and high-risk patients? STUDY DESIGN: We use hospital discharge data to estimate logistic regression models of hospital choice for low-risk and high-risk Medicaid and self-pay/charity maternity patients for 25 metropolitan statistical areas (MSAs) in five states for the years 1991 and 1994. We define low-risk patients as discharges without comorbidities and high-risk patients as discharges with comorbidities that may substantially increase hospital costs, length of stay, or morbidity. The five states are California, Florida, Massachusetts, New Jersey, and New York. The MSAs in the analysis are those with at least one safety-net hospital and a population of 500,000 or more. This study also uses data from the 1990 Census and AHA Annual Survey of Hospitals. The regression analysis estimates the change between 1991 and 1994 in the relative odds of a Medicaid or self-pay/charity patient using a safety-net hospital. We explore whether this change in the relative odds is related to the risk status of the patient. PRINCIPAL FINDINGS: The findings suggest that competition for Medicaid patients increased from 1991 to 1994. Over time, safety-net hospitals lost low-risk maternity Medicaid patients while services to high-risk maternity Medicaid patients and self-pay/charity maternity patients remained concentrated in safety-net hospitals. IMPLICATIONS FOR POLICY: Safety-net hospitals use Medicaid patient revenues and public subsidies that are based on Medicaid patient volumes to subsidize care for uninsured and underinsured patients. If safety-net hospitals continue to lose their low-risk Medicaid patients, their ability to finance care for the medically indigent will be impaired. Increased hospital competition may improve access to hospital care for low-risk Medicaid patients, but policymakers should be cognizant of the potential reduction in access to hospital care for uninsured and underinsured patients. Public policymakers should ensure that safety-net hospitals have sufficient financial resources to care for these patients by subsidizing their care directly.

Comorbidity↗
PubMedDate not supplied

Reasons, health behaviors, and outcomes of no prenatal care: research that changed practice.

Changes in prenatal care practices resulted from a pilot study with 12 urban New Mexican women who received no prenatal care. The women were interviewed regarding their reasons for not receiving care during pregnancy, health behaviors, and perceived neonatal outcomes. Data on actual neonatal outcomes were taken from the medical record. Maternal reasons for no prenatal care were socio-demographic, system-related, attitudinal, and outside forces of job and childcare. To ensure a healthy baby, the women made changes in their nutrition, self-care activities, substance use, sleep, and exercise activities. All of the women perceived they had a healthy baby. Yet 61% of the neonates had complications and 45% were low birth weight. The research findings were used to develop a care management program that included case management and utilization management.

Adult↗
PubMedDate not supplied

HEDIS audits: meeting the challenge.

The Health Plan Employer Data and Information Set (HEDIS) is a tool to measure and report managed care performance. HEDIS has become the industry standard for assessing and comparing the quality of managed care organizations (MCOs), so it is imperative that MCOs collect and communicate HEDIS data correctly and efficiently. Several primary issues face MCOs in compiling HEDIS data. In particular, this article examines the HEDIS audit process and outlines the preparation required to undergo an audit, common errors uncovered in the audit process, and steps that can be taken to ensure compliance with HEDIS technical specifications.

Centers for Medicare and Medicaid Services, U.S.↗
PubMed2002

Treatment outcomes in 3 modes of orthodontic practice.

This study examined differences in pretreatment severity and treatment outcome among orthodontic patients treated in 3 different practice-management modes. Samples of pretreatment (T1) and end of treatment (T2) study casts were selected from traditional private practices (TPP, 3 offices, 81 cases), a dental corporation (COMP, 2 offices, 53 cases), and a dental management service organization (DMSO, 1 office, 36 cases). Orthodontic specialists had treated all patients. Cases were initially selected on a consecutive start basis. From each practice, the first 30 cases satisfying the study criteria were included in the sample. The T1 and T2 study casts were evaluated with the PAR and HLD indexes. The PAR and HLD indexes showed a high level of agreement on T1 cast scores but not on the T2 casts. Mean T1 scores were highest in the COMP cases, followed by the DMSO and the TPP cases. T2 scores were lowest in the TPP cases, followed by the DMSO and the COMP cases. The percentage of PAR score reduction showed that, in all 3 modes, patients were treated to a high standard.

Adolescent↗
PubMed2000

Assessment of the Massachusetts Behavioral Health Program Year 6.

After a difficult transition from the previous vendor to the Massachusetts Behavioral Health Partnership (MBHP), Year 6 was a year of stability and incremental changes for the Massachusetts Behavioral Health Program. This assessment of Year 6 is based on interviews with key players, data provided by the MBHP, a survey of providers, as well as on the fifth year of an ongoing review of the program. Results indicate that enrollment grew, and new services were developed in response to identified needs. Providers considered access, utilization, and quality of care to be the same or better than a year earlier. Coordination improved, but was not optimal. Clinical and overall decisions with MBHP were collaborative or negotiated and less hierarchical in manner than the previous year. Providers rated MBHP better than other managed care organizations on quality of care and utilization review decisions, access, flexibility, and administration.

Child↗
PubMed1993

The link between continuous quality improvement and case management.

During the past several years, the continuous quality improvement (CQI) process has gradually been adapted to the healthcare setting to improve quality without increasing costs. In traditional quality assurance models, quality is measured by the number of accidents or errors occurring. No provision is made for improving the conditions under which the errors occurred. However, continuous quality improvement focuses on the processes used to achieve a goal. These processes may be clinical, financial, or operational issues. Each step in the process is analyzed; then a plan for improvement is tested and refined. The concepts of quality improvement that have been applied in the industrial setting are now being applied in the healthcare arena. Case management and CQI are linked in philosophy and process. The steps of the CQI process can be applied to managed care plans from both a clinical and financial perspective.

Costs and Cost Analysis↗