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PubMed2006

Diabetes disease management in Medicaid managed care: a program evaluation.

The objective of this study was to evaluate the outcomes of a diabetes disease management initiative among TennCare's Medicaid Population. A quasi-experimental group design was conducted using a control group and a diabetes disease management intervention group. Primary outcomes measures were rates for three key recommended tests (ie, microalbuminuria, lipids, and hemoglobin A1c). Secondary performance measures --patient satisfaction and program evaluation issues -- also were assessed. The study was performed among TennCare beneficiaries with diabetes mellitus. It utilized a quasi-experimental nonequivalent control group design, with 993 intervention participants in Knoxville and 1167 control group members in Chattanooga. Variables analyzed included testing rates for hemoglobin A1c, lipids, microalbuminuria, and demographics. A logistic regression model using baseline covariates was constructed to analyze the differences between the intervention and the control groups. Intracluster correlations were accounted for by generalized estimating equations. Statistical process control detected process changes in testing rates over time. There were meaningful changes in the rate of ordering recommended tests. The odds of an individual in the intervention group having at least one microalbuminuria test were 196% more (confidence interval [CI] = 1.50, 5.82; p = 0.002); the odds of having at least one lipid profile were 43% more (CI = 1.01, 2.02; p = 0.042); and the odds of having two or more hemoglobin A1c tests were 39% more (CI = 0.87, 2.23; p = 0.165) than the odds of an individual in the control group. The analysis also showed a high rate of satisfaction among patients in the intervention group. The program was successful in meeting its stated goals of providing effective disease management for TennCare patients with diabetes.

Adult↗

PubMed1996

Performance measurement: integrating quality management and activity-based cost management.

The development of an activity-based management system provides a framework for developing performance measures integral to quality and cost management. Performance measures that cross operational boundaries and embrace core processes provide a mechanism to evaluate operational results related to strategic intention and internal and external customers. The author discusses this measurement process that allows managers to evaluate where they are and where they want to be, and to set a course of action that closes the gap between the two.

Accounting↗

PubMed1998

Management service organizations: effective strategy to assume and manage full risk agreements?

A management services organization (MSO) has emerged as one structure to manage professional and hospital risk agreements. Health plans and direct payers are transferring traditional functions to medical groups and health systems under these agreements. How does a hospital and affiliated medical group develop a strategy to assume, manage, and mutually benefit from these agreements? When do market forces dictate whether an MSO is the most appropriate organizational model to utilize? The development of an MSO can offer an effective organizational strategy to capture capitated contracts and assume responsibility for population-based medical services. This article explores the features of such an organization, areas for potential collaboration between the medical group and hospital, as well as the impact on patient care.

Capitation Fee↗

PubMed2000

Disability management: corporate medical department management of employee health and productivity.

This study describes a proactive in-house program for managing short-term disability (STD) in the workforce of a very large banking system. The goals of this program were to (1) minimize the personal and economic impacts of STD by early intervention, (2) validate the extent and duration of STD, and (3) coordinate medical services and provide guidance to managers that would facilitate an early return to work. This program was made possible by the installation of a comprehensive database, called Occupational Medicine and Nursing Information System. This database mainly includes employees' claims for inpatient and outpatient health services, disability and workers' compensation benefits, wellness program participation, medical examinations and laboratory tests, use of prescription drugs, and results of Health Risk Appraisals. As a result of these efforts, STD event duration declined after this STD management program was implemented in locations heretofore outside the system, and by providing full pay for part-time work after STD, within the system as well. Of note, the average number of STD days per employee showed substantial variation by health plan, including the fact that it was higher (3.9 STD days/employee) for health maintenance organization participants than for indemnity plan members (2.7 STD days/employee).

Adult↗

PubMedDate not supplied

Medical management committees promote quality and cost-effective managed care.

MedSpan, a managed care organization, believes it should provide physicians with maximum input regarding utilization management and practice guidelines. This has been accomplished through nine committees, all of which report to a Medical Management/Quality Management Committee. This committee structure has allowed MedSpan to avoid the unilateral imposition of guidelines and has enhanced the quality of care and service while decreasing utilization and reducing costs. Examples of specific physician committee actions are included in this article.

Connecticut↗

PubMedDate not supplied

The evolution of quality management in Medicaid managed care.

Since the early 1990s almost all states have moved some or all of their Medicaid beneficiaries to Medicaid managed care (MMC). Critics have worried about quality since MMC's inception. Proponents argued that state Medicaid agencies, as large-scale purchasers of care, would pursue "value-based purchasing" and other strategies to stimulate quality improvements. In this paper we extend and update previous evaluations of the use of managed care for the Medicaid population, the extent to which beneficiaries receive care from Medicaid only and from commercial health plans, and the quality management programs that state Medicaid agencies supported during 2001.

Health Services Research↗

PubMed1991

The role of health information managers in hospital financial management.

One area of internal analysis that has attracted increasing attention from healthcare managers is product line management. The coded data produced by the health information management professional is integrated with financial data to provide decision makers with valuable information about service quality and profitability.

Abstracting and Indexing↗

PubMed1995

The importance of management information systems in a managed care environment.

Keys to successful information systems for home care providers are planning and control. With managed care's emphasis on data, agencies need to have information systems that can handle the demands managed care puts on agencies today--planning before hurrying to install a system will ensure control as the managed care contracts add up.

Contract Services↗

PubMed1995

Using clinical information to manage managed care.

Clinical records management has always been a sore spot for home care providers. Innovations in computer database management, however, may hold the key to bringing records management under control.

Database Management Systems↗

PubMed1997

Pain management guidelines: implications for managed care--a roundtable discussion.

One of the most important concerns of patients with cancer, particularly those with metastatic disease, is "Will I be in constant pain?" This is a similar concern voiced by patients with late-stage human immunodeficiency virus infection. The management of chronic pain has enormous implications on a patient's ability to function and on his or her quality of life. In June 1996, Medical Interface convened a panel of experts in Chicago to discuss pain management therapies, guidelines, and how these issues will affect, and be affected by, the managed care environment.

Acquired Immunodeficiency Syndrome↗

PubMed1998

Effects of an asthma management program on the asthmatic member: patient-centered results of a 2-year study in a managed care organization.

OBJECTIVE: To report the results of a 2-year pilot program of asthma education based on National Heart, Lung, and Blood Institute treatment guidelines. PATIENTS AND METHODS: Asthmatic members (n = 6698) of a managed care organization received education about their condition directly or through their primary care physician. Medical and pharmacy administrative claims data were reviewed to measure acute asthma events and prescribed therapies in the first (the baseline) and second years of the study. The claims data were augmented by member surveys from a stratified random sample of 2734 asthmatic patients who were members (6 years of age or older) in the baseline year. RESULTS: Compared with the first year, asthmatic members received fewer inpatient services and the proportion of asthmatic members prescribed oral inhaled corticosteroids increased 30% in the second year. Health-related quality of life, measured with validated general and disease-specific instruments; satisfaction with the quality of care; exposure to patient education; knowledge of the disease; and member's confidence in their ability to manage their disease showed statistically significant improvements during the follow-up year of the program for both adult and child asthmatic members. CONCLUSION: For asthmatic members of this health plan, a comprehensive asthma health management program improved processes of care and outcomes.

Adolescent↗

PubMed2000

Comparative performance assessment in managed care: data envelopment analysis for health care managers.

In health care markets increasingly dominated by managed care, health care managers need sophisticated yet understandable comparative performance assessment methods. Ideally, these methods should provide targets for the managers to improve program or organization performance. This article reviews three comparative performance methodologies with a comprehensive explanation of data envelopment analysis (DEA). DEA is a form of linear programming that allows for the inclusion of multiple input and output/outcome performance variables from a virtually unlimited number of organizations, facilitating meaningful health service provider comparative assessments.

Administrative Personnel↗

PubMed2002

Timeliness of immunizations of children in a Medicaid primary care case management managed care program.

OBJECTIVE: This study assessed the timeliness of immunization for children in a Medicaid managed care primary care case management program controlling for patient and provider predictors of immunization status. METHODS: Using administrative data and patient medical records, up-to-date (UTD) and age appropriate immunization (AAI) status were reviewed for 5598 children. The 4:3:1 immunization series (four diphtheria, pertussis, tetanus vaccinations; three polio vaccinations; and one measles, mumps, rubella vaccination) was the standard. RESULTS: Childhood immunization rates were low when assessed using strict adherence to vaccination recommendations. At age 18 months, 28.3% were classified as UTD, and 6.3% were classified as AAI. Compared to children not up-to-date, UTD children were more likely to have public rather than private providers, to have had older mothers, and less likely to have been African American. Among UTD children, AAI children were more likely to reside in urban areas. CONCLUSIONS: Low-income children continue to be under-immunized, even under a managed care initiative. Health care providers and child health advocates need to continue pressure for programs that will increase adherence to nationally recommended guidelines.

Age Factors↗

PubMed2003

Basic practice management systems. Part II of the dental management pyramid series.

Mastering basic management systems is the first of six levels in the Dental Management Pyramid that determines the future direction of your practice. It is important to avoid the temptation to move from one level to the next until you have addressed all aspects of the current level. All too often, dentists attempt to move up the pyramid without completing each level, leaving incomplete management in other areas. Business systems allow for the highest level of profitability, the lowest stress, and the most enjoyment for you and your team members. They serve as the very foundation on which you build your successful dental practice. In the next installment of this series, leadership skills and team development will be discussed.

Appointments and Schedules↗

PubMedDate not supplied

Integrated billing and accounts receivable management system needed to maximize payments and cope with managed care.

The billing and accounts receivable management process in medical practices today has evolved into a multidisciplinary function. This function requires efficient, coordinated performance by physicians and all staff members, from the point of initial patient contact through aggressive follow-up on delinquent payments for services rendered. Offices with deficient or nonexistent billing and accounts receivable management systems typically experience collection ratios that are less than industry norms. They also experience poor cash flow and unnecessary overhead costs. To avoid costly inefficiencies and ensure that it maximizes payments from third-party payors and patients, a medical practice must have an integrated billing and accounts receivable management system that includes components outlined in this article.

Accounts Payable and Receivable↗

PubMedDate not supplied

Managed care 101. A practical instruction guide to managed care for the orthopaedic office.

Managed care is not a new concept to a majority of the health care professionals in the United States. However, certain health care markets historically are more competitive than others, particularly on the West coast and in the Southwest. These areas were the proving grounds for a now well established national trend. Managed care is now beginning to make strong footholds in eastern seaboard communities. As managed care companies gain market share in the East, orthopaedic offices must learn to successfully cope with numerous changes to their office routines, patient populations, and reimbursement levels.

Humans↗

PubMed1997

Total quality management issues in managed care.

The implementation of total quality management (TQM) in health care has gone on in parallel with the growth of managed care. What is the interaction between the two? Key issues are the ascendance of cost control over quality in many areas, erosion of employee commitment and loyalty, and a short-run orientation. Associated with this is an emphasis on organizational learning rather than learning by autonomous professionals. Both TQM and managed care acknowledge the dynamic nature of clinical processes and the ability and responsibility of both institutions and clinicians to improve their processes. Both are consistent with efforts to identify and implement best practices. However, these similarities should not mask fundamental differences. Continuous improvement must shift its focus from avoiding unnecessary variation to facilitating rapid organizational learning and institutionalizing mass customization into the delivery of health services.

Humans↗

PubMed2005

Changes in isotretinoin prescribing before and after implementation of the System to Manage Accutane Related Teratogenicity (SMART) risk management program.

PURPOSE: To assess changes in isotretinoin prescribing following the implementation of the System to Manage Accutane Related Teratogenicity (SMART) risk management program. METHODS: Using nationally representative commercial data resources on prescription drug dispensing patterns, surveys of office-based physician practices, and a large, claims database from a pharmacy benefits manager (PBM), we examined the total number of isotretinoin prescriptions (new and refill), prescriber speciality, and patient characteristics (age, gender, severity of acne indication) in the year before (April 2001-March 2002) and the year following (April 2002-March 2003) implementation of the SMART program. RESULTS: In the 12-months prior to SMART, 1 508 000 prescriptions were dispensed for isotretinoin, declining approximately 23% to 1 160 000 prescriptions in the year following SMART. There was little or no change in prescriber specialty, severity of acne, and patient age and gender. CONCLUSION: SMART may have lead to a decrease in isotretinoin prescriptions. Further research is needed to determine whether the reduced number of isotretinoin prescriptions reflects appropriate use or inhibited use resulting in loss of access to the product's benefits.

Adolescent↗