PubMed Health⌕ Search

SEARCH · PubMed Health

Results for “Managed Care Programs”

Explore indexed PubMed citations for clinical trials, systematic reviews and public health research. Read source abstracts and follow each citation to its original PubMed record.

Quote a phrase for an exact phrase match. Source license links do not imply unrestricted reuse.

At least 1,045 records · Page 58Linked to original sources
PubMedDate not supplied

Redesigning case management in managed care: an eclectic approach: from city to ranch.

Case management programs are a common approach to managing the quality and cost of services in managed care organizations. Once developed these programs may grow stagnate as the managed care member population grows and changes. This article presents a redesign project initiated by a managed care organization located in a rural Southwest region of the United States. Nursing theory and case management standards of practice form the basis of the redesign project and will be discussed. The case management model, including roles and responsibilities of staff, are presented. Results and future implications are identified.

Case Management↗
PubMed2001

Care for children with special health care needs in a managed care system: a patient satisfaction survey.

In 1994 the government of Puerto Rico adopted a capitated managed health care system for the medically indigent. The new law has been implemented in most municipalities. A survey of children with special health care needs treated at a tertiary pediatric center under the capitated managed care system and the prior non-capitated system was analyzed using the Consumer Assessments of Health Plan Survey (CHAPS) instrument. One third of the patients who were under the new capitated managed care system were not satisfied with the medial care they were receiving. The parents of children with multidisciplinary conditions found it much more difficult to access care at the tertiary center. It took parents two years to learn to navigate within the capitated managed care system. Studies to measure outcome and health quality of children with special health care needs in capitated managed health care programs must be developed to learn how the potential benefits of managed care can be maximized and the potential harms minimized. The purpose of this study was to analyze the accessibility and satisfaction of caretakers of children with special health care needs under a capitated managed health care system.

Adolescent↗
PubMed1997

Don't rely on MCOs--take systems approach to physician practice data collection.

Physician practices can thrive under capitation with proper data collection. Practices should take a systems approach to managing the financial, operations, and clinical aspects of their businesses--and this requires data. While some of it may be acquired from MCOs, most physicians will have to rely on IPAs or PHOs to do the dirty work. Here's a laundry list of data to collect, plus report templates.

Data Collection↗
PubMed1997

The future of dental benefits.

The past twenty years have seen dramatic growth and consolidation in DHMO and PPO segments of the dental benefits industry. Purchasers and patients are becoming more vocal in their demands, primarily for controlling costs. It is predicted that emerging trends will include greater emphasis on quality (and its relationship to cost) and on dental practice management companies. It is less clear what role organized dentistry will play in these changes.

Cost Control↗
PubMed1999

A proposed managed-care curriculum for podiatric residencies.

This article describes a curriculum that could be included in podiatric residencies to help residents function successfully in a managed-care environment. Various groups have identified and implemented the competencies necessary to function within such an environment. Podiatric residents, who are well trained in the clinical management of podiatric problems, can succeed in a managed-care environment if residency programs include training objectives and methods to address these competencies. This article describes the managed-care components of two primary-care residency programs and a podiatric program and proposes a managed-care curriculum for podiatric residencies. The author's goal is to educate residency directors and faculty members on possible objectives and methods that can enhance the podiatric resident's educational experience and knowledge of managed care.

Curriculum↗
PubMed2001

Two-year effects of quality improvement programs on medication management for depression.

BACKGROUND: Significant underuse of evidence-based treatments for depression persists in primary care. We examined the effects of 2 primary care-based quality improvement (QI) programs on medication management for depression. METHODS: A total of 1356 patients with depressive symptoms (60% with depressive disorders and 40% with subthreshold depression) from 46 primary care practices in 6 nonacademic managed care organizations were enrolled in a randomized controlled trial of QI for depression. Clinics were randomized to usual care or to 1 of 2 QI programs that involved training of local experts who worked with patients' regular primary care providers (physicians and nurse practitioners) to improve care for depression. In the QI-medications program, depression nurse specialists provided patient education and assessment and followed up patients taking antidepressants for up to 12 months. In the QI-therapy program, depression nurse specialists provided patient education, assessment, and referral to study-trained psychotherapists. RESULTS: Participants enrolled in both QI programs had significantly higher rates of antidepressant use than those in the usual care group during the initial 6 months of the study (52% in the QI-medications group, 40% in the QI-therapy group, and 33% in the usual care group). Patients in the QI-medications group had higher rates of antidepressant use and a reduction in long-term use of minor tranquilizers for up to 2 years, compared with patients in the QI-therapy or usual care group. CONCLUSIONS: Quality improvement programs for depression in which mental health specialists collaborate with primary care providers can substantially increase rates of antidepressant treatment. Active follow-up by a depression nurse specialist in the QI-medications program was associated with longer-term increases in antidepressant use than in the QI model without such follow-up.

Adult↗
PubMed1996

OR management.

Market forces throughout the US, especially in specific geographic areas, have brought about profound changes in health care delivery. One of the most significant is the move to managed and capitated care with the resulting impact on hospital reimbursement. As these forces gain momentum, continually moving further from fee for-service, the hospital portion of the healthcare dollar continues to contract. In response, healthcare delivery organizations are developing innovative strategies to ensure the continual provision of cost effective care. Emphasis is placed upon keeping resources close to the point-of-care delivery. Necessary savings, reductions, and efficiencies must come from structural change, reengineering, best practice development, and more cost effective care delivery with highly standardized use of resources. Healthcare is in a transitionary stage. The transition has been from providing acute inpatient care to managing the continuum of care, from treating illness in individuals to providing education and maintaining wellness in the defined population. Revenue centers are no longer recognized; rather, in this increasingly capitated market, all, including operating rooms, are cost centers. The focus is no longer on filling beds, ORs, radiology suites, etc. The challenge is to find effective methods to minimize the needed resources to deliver high quality, cost effective care while maintaining and increasing patient and physician satisfaction. This article focuses on surgery in a large integrated system, Sharp Health care (San Diego, CA), a network of organizations providing, or arranging to provide, a coordinated continuum of services to a defined population.

California↗
PubMed2006

Long-term effectiveness and cost of a systematic care program for bipolar disorder.

CONTEXT: Despite the availability of efficacious treatments, the long-term course of bipolar disorder is often unfavorable. OBJECTIVE: To test the effectiveness of a multicomponent intervention program to improve the quality of care and long-term outcomes for persons with bipolar disorder. DESIGN: Randomized controlled trial with allocation concealment and blinded outcome assessment. SETTING: Mental health clinics of a group-model prepaid health plan. PATIENTS: Of 785 patients in treatment for bipolar disorder who were invited to participate, 509 attended an evaluation appointment, 450 were found eligible to participate, and 441 enrolled in the trial. INTERVENTIONS: Participants were randomly assigned to a multicomponent intervention program or to continued care as usual. Three nurse care managers provided a 2-year systematic intervention program, including the following: a structured group psychoeducational program, monthly telephone monitoring of mood symptoms and medication adherence, feedback to treating mental health providers, facilitation of appropriate follow-up care, and as-needed outreach and crisis intervention. MAIN OUTCOME MEASURES: In-person blinded research interviews every 3 months assessed mood symptoms using the Longitudinal Interval Follow-up Examination. Health plan administrative records were used to assess the use and cost of mental health services. RESULTS: Intent-to-treat analyses demonstrated that the intervention significantly reduced the mean level of mania symptoms (z = 2.09, P = .04) and the time with significant mania symptoms (19.2 vs 24.7 weeks; F(1) = 6.0, P = .01). There was no significant intervention effect on mean level of depressive symptoms (z = 0.19, P = .85) or time with significant depressive symptoms (47.6 vs 50.7 weeks; F(1) = 0.56, P = .45). Benefits of the intervention were found only in a subgroup of 343 persons with clinically significant mood symptoms at the baseline assessment. The incremental cost (adjusted) of the intervention was 1251 dollars (95% confidence interval, 55-2446 dollars), including approximately 800 dollars for the intervention program services and an approximate 500 dollars increase in the costs of other mental health services. CONCLUSIONS: Population-based systematic care programs can significantly reduce the frequency and severity of mania in bipolar disorder, and cost increases are modest considering the clinical gains. The incorporation of more specific cognitive and behavioral content or more effective medication regimens may be necessary to significantly reduce the symptoms of depression.

Adult↗
PubMed2006

The influence of managed care on U.S. baccalaureate nursing education programs.

The transformation of health care into managed care has raised many issues and concerns for nurse educators. The milieu in which nurses currently practice reflects the restructuring shaped by managed care principles. The shift from acute care to expanded community services has changed the way health care is provided within hospital settings. The organization of nursing programs has been affected by this shift, and the ramifications of these external forces on curriculum structure have altered the way nursing students are educated. This article presents research demonstrating the changes in the structure of the curricula for baccalaureate nursing education in 2001, which were caused by health care reform in effect since 1994.

Case Management↗
PubMed1988

Quality assurance of brokered services.

Case management programs that contract for client services act, in effect, as brokers of these services. Senior Care Network (SCN), a hospital-based, comprehensive, long term care program that includes a case management component, developed a quality assurance (QA) program to ensure the quality of its brokered services. At SCN, quality is controlled through a rigorous, systematic vendor selection process for service vendors and through vendor performance monitoring. Specific monitoring methods include incident reporting, quarterly meetings with vendors, client home visits, site visits to vendor offices, and annual vendor performance evaluations. Extensive external review requirements may eventually be added to the QA program to make it even more comprehensive.

Aged↗
PubMed1996

The role of adjunctive therapy in the management of chronic nonmalignant pain.

The management of chronic nonmalignant pain is an increasing challenge to clinicians and their patients. Adjunctive therapy, which includes a wide range of physical, psychoeducational, and multidisciplinary interventions, can play an important role in the treatment of pain. This article discusses the role and efficacy of adjunctive therapy in the management of pain associated with musculoskeletal conditions, the most common and disabling sources of chronic nonmalignant pain. Findings from meta-analyses, review articles, and recent clinical trials are reviewed that suggest that interventions that combine exercise and psychoeducational approaches designed to enhance communication, control, problem-solving, and coping can have a clinically significant impact on reducing pain and improving functional status for many conditions.

Chronic Disease↗
PubMed1999

Roadblocks to effective pain treatment.

Managed care "backlash" rhetoric to the contrary, roadblocks to effective pain treatment occur both intrinsic and extrinsic to the healthcare system. Pain medicine, an emerging, formally recognized specialty, and the special population of patients which it serves, experience additional discreet barriers. Chief among these is a lack of clear identity and recognition of the specialty and the disenfranchisement of many of the patients it serves in the American healthcare system. Special problems within various healthcare financing environments is discussed.

Government↗