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At least 91 records · Page 5Linked to original sources
PubMed1996

Evaluating health care management programs and schools of public health: some experiences in Europe.

The European Healthcare Management Association (EHMA) has built upon the ACEHSA model of accreditation to develop a European version-- program review--which takes account of the variety of health systems, cultures, and languages in Europe. This article describes the manner in which EHMA's ¿program review¿ evolved, and the distinctive features of the process. It then analyzes some of the lessons that have emerged from the twenty-two evaluations completed in nine countries, distinguishing between issues of effectiveness (needs, objectives, and outcomes) and efficiency (inputs, processes, and outputs). It concludes by reviewing the efficacy of the methodology.

Accreditation↗
PubMed2001

Predictive modeling care management program produces dramatic bottom line results.

It's a new-generation effort, but it has already proven its worth in a large population, producing savings of $1 million to $2 million per month. The effort begins with the development of a constantly evolving registry of high-risk patients. Specialized case management efforts are then focused on stabilizing individuals within this group. See how traditional interventions have been combined with new technology to deliver results.

Algorithms↗
PubMed2001

Predictive modeling care management program produces dramatic bottom line results.

Predictive modeling program identifies high-risk patients before complications lead to skyrocketing costs. It's a new-generation effort, but it has already proven its worth in a large population, producing savings of $1 million to $2 million per month. The effort begins with the development of a constantly evolving registry of high-risk patients. Specialized case management efforts are then focused on stabilizing individuals within this group. See how traditional interventions have been combined with new technology to deliver results.

Algorithms↗
PubMed1998

Medicaid program; Medicaid managed care--HCFA. Proposed rule.

This proposed rule would amend the Medicaid regulations to allow the States greater flexibility by giving them the option to require Medicaid recipients to enroll in managed care entities without obtaining waivers. These revisions, which are authorized by the Balanced Budget Act of 1997, would establish new beneficiary protections in areas such as quality assurance, grievance rights, and coverage of emergency services. They would eliminate certain requirements viewed by State agencies as impediments to the growth of managed care programs, such as the enrollment composition requirement, the right to disenroll without cause at any time, and the prohibition against enrollee cost-sharing. They would also permit State agencies to amend their State plans to require enrollment in managed care organizations subject to certain conditions, including limits on whose enrollment can be mandated, and a requirement for beneficiary choice. In addition, this rule would extend most of these new requirements to prepaid health plans.

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

Medicaid program; Medicaid managed care: new provisions. Final rule.

This final rule amends the Medicaid regulations to implement provisions of the Balanced Budget Act of 1997 (BBA) that allow the States greater flexibility by permitting them to amend their State plan to require certain categories of Medicaid beneficiaries to enroll in managed care entities without obtaining waivers if beneficiary choice is provided; establish new beneficiary protections in areas such as quality assurance, grievance rights, and coverage of emergency services; and eliminate certain requirements viewed by State agencies as impediments to the growth of managed care programs, such as, the enrollment composition requirement, the right to disenroll without cause at any time, and the prohibition against enrollee cost-sharing.

Centers for Medicare and Medicaid Services, U.S.↗
PubMed2001

Medicaid program; Medicaid managed care. Health Care Financing Administration (HCFA), HHS. Final rule with comment period.

This final rule with comment period amends the Medicaid regulations to implement provisions of the Balanced Budget Act of 1997 (BBA) that allow the States greater flexibility by permitting them to amend their State plan to require certain categories of Medicaid beneficiaries to enroll in managed care entities without obtaining waivers if beneficiary choice is provided; establish new beneficiary protections in areas such as quality assurance, grievance rights, and coverage of emergency services; eliminate certain requirements viewed by State agencies as impediments to the growth of managed care programs, such as the enrollment composition requirement, the right to disenroll without cause at any time, and the prohibition against enrollee cost-sharing. In addition, this final rule expands on regulatory beneficiary protections provided to enrollees of prepaid health plans (PHPs) by requiring that PHPs comply with specified BBA requirements that would not otherwise apply to PHPs.

Budgets↗
PubMed1998

Case management programs in primary care.

To review the impact of case management programs on health care resource use; their impact on patient satisfaction, quality of life, and functional status (patient-centered outcomes); and their cost-effectiveness, we reviewed the English language literature utilizing the following MEDLINE and HealthSTAR headings: case management, patient care planning, patient-centered care, disease management, care management, and managed care programs. Bibliographies of relevant articles were also reviewed. Only randomized controlled trials were included. Data were extracted manually from relevant publications and are presented descriptively because formal, quantitative methods were not applicable. Nine studies met our inclusion criteria. Of the seven studies examining case management's impact on health resource use, only two found a positive effect. Both successful programs targeted patients with specified disease conditions and care was supervised by a medical subspecialist. None of the programs targeting general disease conditions or supervised by generalists reported a positive effect. All six studies examining patient-centered outcomes reported a positive impact. These effects were unrelated to the patient's conditions or the study personnel. Both studies examining clinical parameters found a positive impact. Only three studies examined costs; all reported nonsignificant cost savings. While case management programs offer theoretical benefits, few examples of successful programs were found. Positive effect was related to disease condition and specialty training of study personnel. Patient-centered outcomes were often improved upon but at unknown cost. Further multisite clinical trials are needed to define case management's role in our future health care system.

Case Management↗
PubMed1997

Pricing specialty carve-outs and disease management programs under managed care.

The drive toward improved efficiency and effectiveness in health care has spawned disease management programs to address the needs of patients with certain conditions. These programs parallel traditional case management programs in monitoring patients, but disease management differs from case management in early assessment of patient risk, with proactive clinical interventions and educational efforts. The most comprehensive programs include a coordinated delivery system that can be "carved out" from other health care benefits. Pricing disease management can benefit from the analysis of detailed, disease-specific and community-specific data from public or private sources.

Capitation Fee↗
PubMed1996

Assuring quality of care for children with special needs in managed care organizations: roles for pediatricians.

Increasing numbers of children with special health care needs are enrolling in managed care programs. Although managed care may improve service coordination and use of primary care, it may also threaten health outcomes for these children by potentially decreasing access to the range of needed services, eroding progress in developing community-based service systems, and failing to assure quality of care. To date, few frameworks have been proposed to assess quality of care for this population of children in managed care organizations. In this article, we adapt the Institute of Medicine's definition of quality and identify six key components: content of service delivery systems, the nature of desired health outcomes, risks associated with service delivery, constraints of care, interpersonal dimensions, and attention to developmental issues. These components can be assessed at three levels: the individual, the health plan, and the community. Pediatricians and other child health professionals have critical roles to play in assuring that policies and practices within managed care organizations promote a high quality of care for this vulnerable population of children.

Child↗