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PubMed2000

Telephone medicine for internists.

The role of the telephone in medical practice is important, but often problematic. Mistakes in telephone diagnosis and triage can have severe consequences. An effective office system can reduce liability risks, and in some cases telephone contact can substitute for office visits. Internists feel unprepared to provide telephone care. Therefore, residency education needs to focus on documentation, consultant availability, and performance feedback. Research should focus on improving outcomes, reimbursement issues, and technologic advances. This article describes internists' telephone interactions with ambulatory patients, preparation for telephone medicine, and aspects of office telephone systems and makes comparisons with other primary care fields.

Ambulatory Care↗
PubMed1995

Physician use of information technology in ambulatory medicine: an overview.

Physicians practicing ambulatory medicine have never had more opportunities to use information technology to help them in their everyday practice. In parallel, evolving health care industry dynamics are increasing the need for clinical computer applications, which help improve the quality, efficiency, and the cost-effectiveness of patient care. This article examines: (1) the information needs of practicing physicians, (2) current and emerging technologies that can improve clinical decision making at the point of care, and (3) the impact of these technologies on clinical quality, medical costs, and physician practice efficiency. The article uses patient case scenarios to illustrate the emerging role of information technology in patient care.

Ambulatory Care Information Systems↗
PubMedDate not supplied

Integration and its discontents: substance abuse treatment in the Oregon Health Plan.

With the creation of the Oregon Health Plan (OHP) in 1994, Oregon placed its Medicaid program under a managed care system. This paper examines the managed care practices of seven health plans serving OHP enrollees between 1996 and 1998. Results indicated that the original vision of integrating substance abuse treatment services with physical care for OHP enrollees evolved into a multilayered, carved-out approach. Factors working against integration included changes in the administration and management of the chemical dependency benefit, financial losses by health plans, and lack of training and incentives for physicians to refer clients to substance abuse treatment.

Delivery of Health Care, Integrated↗
PubMed1994

Managed care and the radiologist: expectations and future trends.

Our health care system, burdened by excessive costs and unprecedented growth, is in need of reform. How to carry out such reform and achieve an acceptable balance between quality and cost of care remains the dilemma. Attempts to control costs and limit growth have, in recent years, produced a disturbing trend in the quality and availability of health care benefits, focusing on benefit reduction without addressing resource utilization or quality of care. The result of these efforts? Persons who have health care insurance are paying more for basic plans and reduced benefits; others are either uninsured or underinsured. Health care benefits continue to be the fastest growing component of business expenses, strengthening the perception of diminishing competitiveness in the world market. The formation of smaller businesses offering no health care benefits continues to be problematic.

Cost Control↗
PubMed2001

Assessments of managed care organizations in the Greater Baton Rouge area by physicians and physicians' office managers.

Health care quality assessment under managed care organizations is usually derived from two sources: (1) consumer satisfaction surveys, and (2) The Health Plan Employer Data Information Set reports. There is little published data regarding physicians' critiques. This study surveyed physicians and office managers as to the quality of healthcare under 10 managed care organizations in the Greater Baton Rouge area. Performance indicators in the physician questionnaire focused on personal satisfaction, perception of patient satisfaction, and mental health coverage. The office managers' checklist included payment and certification issues, telephone time spent gaining certification, level of knowledge among plan enrollees of their benefits, appeal process, and adequacy of reimbursement. Means were calculated for each performance indicator and managed care organizations were ranked. Tukey-Kramer's post-hoc multiple comparisons test was used to confirm rank order validity. Significant differences were found among companies. Significant rank-order agreement by both physicians and office managers was evident. The usefulness of such surveys and performing them annually is discussed.

Attitude of Health Personnel↗
PubMed1997

Targeting excellence in today's marketplace.

Managed care has greatly affected the health care marketplace in medicine and, to a lesser extent, in dentistry. These systems encourage over- and undertreatment of patients; and those patients, and their employers, are beginning to take notice. Meanwhile, the modern patient has become increasingly concerned with receiving excellent service. In this still-evolving marketplace, there lies challenge and opportunity for dentists.

Consumer Behavior↗
PubMed2001

Care management of work injuries: results of a 1-year pilot outcome assurance program.

A 1-year pilot study was conducted, linking the efforts of a workers' compensation managed care organization with those of an occupational health clinic and emergency department of manage work-related injuries and associated work disability. Sustained (> 90 day), injury-specific return-to-work outcomes, modified by job title, were compared with loosely managed and well-managed benchmarks. The mean return-to-work outcome, measured as lost workdays (LWDs), was 5.11 +/- 21.0 LWDs for 418 workers. These results exceeded benchmarks for both loosely managed care, 14.0 +/- 17.2 LWDs, P < 0.001 (8.9 fewer LWDs/case), and optimally case-managed care, 6.99 +/- 7.64 LWDs, P = 0.044 (1.9 fewer LWDs/case). An estimate of the value of these saved LWDs to the employers-at $200 per workday was $740,400 for the loosely managed benchmarks and $157,000 for the well-managed benchmarks. The Outcome Assurance Program virtually eliminated typical delays in the diagnosis and medical management of these injured workers.

Accidents, Occupational↗
PubMed2000

High-risk population health management--achieving improved patient outcomes and near-term financial results.

OBJECTIVE: A managed care organization sought to achieve efficiencies in care delivery and cost savings by anticipating and better caring for its frail and least stable members. STUDY DESIGN: Time sequence case study of program intervention across an entire managed care population in its first year compared with the prior baseline year. PATIENTS AND METHODS: Key attributes of the intervention included predictive registries of at-risk members based on existing data, relentless focus on the high-risk group, an integrated clinical and psychosocial approach to assessments and are planning, a reengineered care management process, secured Internet applications enabling rapid implementation and broad connectivity, and population-based outcomes metrics derived from widely used measures of resource utilization and functional status. RESULTS: Concentrating on the highest-risk group, which averaged just 1.1% prevalence in the total membership, yielded bottom line results. When the year before program implementation (July 1997 through June 1998) was compared with the subsequent year, the total population's annualized commercial admission rate was reduced 5.3%, and seniors' was reduced 3.0%. A claims-paid analysis exclusively of the highest-risk group revealed that their efficiencies and savings overwhelmingly contributed to the membershipwide effect. This subgroup's costs dropped 35.7% from preprogram levels of $2590 per member per month (excluding pharmaceuticals). During the same time, patient-derived cross-sectional functional status rose 12.5%. CONCLUSIONS: A sharply focused, Internet-deployed case management strategy achieved economic and functional status results on a population basis and produced systemwide savings in its first year of implementation.

Algorithms↗
PubMed1996

Promoting use of a preferred histamine H2-receptor antagonist in managed care organizations.

A program to promote generic cimetidine as the preferred histamine H2-receptor antagonist (HRA) in the managed care organizations (MCOs) served by a pharmacy benefit management company is described. A pharmacy benefit management company conducted a literature review to substantiate the therapeutic equivalence of the HRAs and to set conservative criteria for identifying candidates for conversion to oral cimetidine therapy. During the third quarter of 1994, the prescriber for each patient identified was sent a document listing the patient's current HRA therapy, the date of his or her last prescription refill, and the name and telephone number of the dispensing pharmacy. A letter summarized the literature; outlined the criteria used to identify candidate patients; gave the current indications, dosages, and average wholesale prices of the HRAs; and asked the prescriber to switch the patient to generic cimetidine. HRA use in an MCO that participated in the program was compared with HRA use in a nonparticipating MCO for the second quarter of 1994 (the baseline period), the fourth quarter of 1994, and the first quarter of 1995. The nonparticipating MCO showed no change between baseline and 1995 in the proportion of HRA prescriptions accounted for by brand-name and generic cimetidine combined (14% for each period). The average acquisition cost per HRA prescription remained about $75 for each study quarter. In the participating MCO, the proportion of HRA prescriptions accounted for by brand-name plus generic cimetidine increased from 18% at baseline to 39% in the first quarter of 1995. The average acquisition cost per HRA prescription fell from $71 at baseline to $65 in the first quarter of 1995. A program to shift the use of brand-name HRAs to generic cimetidine in MCOs successfully altered prescribing patterns and reduced expenditures for these agents.

Cimetidine↗