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Health Care Financing Review最新文献

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Disenrollment information and Medicare plan choice: is more information better? 注销信息和医疗保险计划选择:信息越多越好吗?
Health Care Financing Review Pub Date : 2007-01-01
Mark D Spranca, Marc N Elliott, Rebecca Shaw, David E Kanouse
{"title":"Disenrollment information and Medicare plan choice: is more information better?","authors":"Mark D Spranca,&nbsp;Marc N Elliott,&nbsp;Rebecca Shaw,&nbsp;David E Kanouse","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>To help Medicare beneficiaries and their intermediaries select the best health plan, CMS publicly reports comparative plan information. Using a laboratory version of Medicare Health Plan Compare that involved a simulated plan choice by 359 Medicare intermediaries, we experimentally investigated plan recommendations with and without disenrollment information and time constraints for viewing materials. Results indicated that the presence of disenrollment information reduced time spent on other measures of plan performance. It also reduced decision quality for less educated intermediaries. Designers and sponsors of consumer-oriented materials should recognize that more information is not always better.</p>","PeriodicalId":55071,"journal":{"name":"Health Care Financing Review","volume":"28 3","pages":"47-59"},"PeriodicalIF":0.0,"publicationDate":"2007-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4194995/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"26841977","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Risk adjustment and public reporting on home health care. 家庭保健的风险调整和公开报告。
Health Care Financing Review Pub Date : 2007-01-01
Christopher M Murtaugh, Timothy Peng, Hakan Aykan, Gil Maduro
{"title":"Risk adjustment and public reporting on home health care.","authors":"Christopher M Murtaugh,&nbsp;Timothy Peng,&nbsp;Hakan Aykan,&nbsp;Gil Maduro","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>Risk adjustment is a critical tool in public reporting of quality measures. Its aim is to level the playing field so that providers serving different patients can be meaningfully compared. We used a theory and evidence-based approach to develop risk-adjustment models for the 10 publicly reported home health quality measures and compared their performance with current models developed using a data-driven stepwise approach. Overall, the quality ratings for most agencies were similar regardless of approach. Theory and evidence-based models have the potential to simplify risk adjustment, and thereby improve provider and consumer understanding and confidence in public reporting.</p>","PeriodicalId":55071,"journal":{"name":"Health Care Financing Review","volume":"28 3","pages":"77-94"},"PeriodicalIF":0.0,"publicationDate":"2007-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4194996/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"26841979","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Public reporting of quality information on Medicaid health plans. 公开报告医疗补助计划的高质量信息。
Health Care Financing Review Pub Date : 2007-01-01
Suzanne Felt-Lisk, Allison Barrett, Rebecca Nyman
{"title":"Public reporting of quality information on Medicaid health plans.","authors":"Suzanne Felt-Lisk,&nbsp;Allison Barrett,&nbsp;Rebecca Nyman","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>Transparency through public reporting of quality data is key to achieving the Institute of Medicine's (IOM) vision for 21st century health care. This article reviews the status of States' voluntary public reporting of Medicaid managed care (MMC) quality data, and analyzes these data. Twenty-one States, including 17 of the 20 largest managed care States, have made plan-level data publicly available online, although the data are sometimes thin, with few measures reported, hard-to-access, and old. We conclude that CMS could better leverage the power of public reporting for quality improvement (QI) by increasing the visibility of health plan employer data and information set (HEDISV) data that States already collect.</p>","PeriodicalId":55071,"journal":{"name":"Health Care Financing Review","volume":"28 3","pages":"5-16"},"PeriodicalIF":0.0,"publicationDate":"2007-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4194989/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"26842042","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Prescription drug use and expenditures among dually eligible beneficiaries. 双重资格受益人的处方药使用和支出。
Health Care Financing Review Pub Date : 2007-01-01
Ann D Bagchi, Dominick Esposito, James M Verdier
{"title":"Prescription drug use and expenditures among dually eligible beneficiaries.","authors":"Ann D Bagchi, Dominick Esposito, James M Verdier","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>Using Medicaid Analytic eXtract (MAX) claims files for 1999 and 2001, the authors describe patterns of prescription drug use and expenditures among dually eligible Medicare and Medicaid beneficiaries for all Medicaid full dually eligible beneficiaries and three important subgroups: (1) aged, (2) disabled, and (3) full-year nursing home residents. The analyses indicate great variation in use and expenditures across States that cannot be explained through differences in use of cost containment strategies. Further, the findings suggest that Medicare Part D plans may achieve significant savings by providing incentives for greater use of generic drugs.</p>","PeriodicalId":55071,"journal":{"name":"Health Care Financing Review","volume":"28 4","pages":"43-56"},"PeriodicalIF":0.0,"publicationDate":"2007-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4195002/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"26909050","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Physician code creep: evidence in Medicaid and State Employee Health Insurance billing. 医生代码蠕变:医疗补助和州雇员健康保险账单的证据。
Health Care Financing Review Pub Date : 2007-01-01
Eric E Seiber
{"title":"Physician code creep: evidence in Medicaid and State Employee Health Insurance billing.","authors":"Eric E Seiber","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>This study estimates a fixed effects ordered logit model physician office visit billing using claims data from South Carolina Medicaid and the State Employees Health Plan. The results find code creep increasing expenditures on physician office visits at a rate of 2.2 percent annually for both programs, with no significant difference in the rate between the two. The models also indicate that physician billing patterns differ between the programs, with the Medicaid claims averaging 1.3 percent less per visit than comparable State Employees Health Plan claims.</p>","PeriodicalId":55071,"journal":{"name":"Health Care Financing Review","volume":"28 4","pages":"83-93"},"PeriodicalIF":0.0,"publicationDate":"2007-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4195000/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"26909867","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Hospital response to public reporting of quality indicators. 医院回应公众报告的质量指标。
Health Care Financing Review Pub Date : 2007-01-01
Mary Laschober, Myles Maxfield, Suzanne Felt-Lisk, David J Miranda
{"title":"Hospital response to public reporting of quality indicators.","authors":"Mary Laschober,&nbsp;Myles Maxfield,&nbsp;Suzanne Felt-Lisk,&nbsp;David J Miranda","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>Senior hospital executives responding to a 2005 national telephone survey conducted for the Centers for Medicare & Medicaid Services (CMS) report that Hospital Compare and other public reports on hospital quality measures have helped to focus hospital leadership attention on quality matters. They also report increased investment in quality improvement (QI) projects and in people and systems to improve documentation of care. Additionally, more consideration is given to best practice guidelines and internal sharing of quality measure results among hospital staff Large, Joint Commission on Accreditation of Healthcare Organizations (JCAHO) accredited hospitals appear to be responding to public reporting efforts more consistently than small, non-JCAHO accredited hospitals.</p>","PeriodicalId":55071,"journal":{"name":"Health Care Financing Review","volume":"28 3","pages":"61-76"},"PeriodicalIF":0.0,"publicationDate":"2007-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4194994/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"26841978","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Profiling efficiency and quality of physician organizations in Medicare. 医疗保险中医生组织的效率和质量分析。
Health Care Financing Review Pub Date : 2007-01-01
Gregory C Pope, John Kautter
{"title":"Profiling efficiency and quality of physician organizations in Medicare.","authors":"Gregory C Pope,&nbsp;John Kautter","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>This article presents a methodology for profiling the cost efficiency and quality of care of physician organizations (POs). The method is implemented for the Boston metropolitan area using 2002 Medicare claims. After adjustments for case mix and other factors, 4 of 30 organizations are identified with different than average efficiency Twenty-one of 30 organizations are identified with a different composite quality of care than average. Without changes in PO behavior, the gains from redirecting patients from lower to higher efficiency and quality providers are likely to be limited.</p>","PeriodicalId":55071,"journal":{"name":"Health Care Financing Review","volume":"29 1","pages":"31-43"},"PeriodicalIF":0.0,"publicationDate":"2007-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4195015/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"27532268","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Financial Gains and Risks in Pay-for-Performance Bonus Algorithms 绩效奖金算法中的财务收益与风险
Health Care Financing Review Pub Date : 2007-01-01 DOI: 10.3768/rtipress.2011.bk.0002.1103.8
J. Cromwell, E. Drozd, Kevin W. Smith, M. Trisolini
{"title":"Financial Gains and Risks in Pay-for-Performance Bonus Algorithms","authors":"J. Cromwell, E. Drozd, Kevin W. Smith, M. Trisolini","doi":"10.3768/rtipress.2011.bk.0002.1103.8","DOIUrl":"https://doi.org/10.3768/rtipress.2011.bk.0002.1103.8","url":null,"abstract":"Considerable attention has been given to evidence-based process indicators associated with quality of care, while much less attention has been given to the structure and key parameters of the various pay-for-performance (P4P) bonus and penalty arrangements using such measures. In this article we develop a general model of quality payment arrangements and discuss the advantages and disadvantages of the key parameters. We then conduct simulation analyses of four general P4P payment algorithms by varying seven parameters, including indicator weights, indicator intercorrelation, degree of uncertainty regarding intervention effectiveness, and initial baseline rates. Bonuses averaged over several indicators appear insensitive to weighting, correlation, and the number of indicators. The bonuses are sensitive to disease manager perceptions of intervention effectiveness, facing challenging targets, and the use of actual-to-target quality levels versus rates of improvement over baseline.","PeriodicalId":55071,"journal":{"name":"Health Care Financing Review","volume":"29 1","pages":"5 - 14"},"PeriodicalIF":0.0,"publicationDate":"2007-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"69977264","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 9
Composite health plan quality scales. 综合保健计划质量量表。
Health Care Financing Review Pub Date : 2007-01-01
Todd Caldis
{"title":"Composite health plan quality scales.","authors":"Todd Caldis","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>This study employs exploratory factor analysis and scale construction methods with commercial Health Plan Employers Data Information Set (HEDISS) process of care and outcome measures from 1999 to uncover evidence for a unidimensional composite health maintenance organization (HMO) quality scale. Summated scales by categories of care are created and are then used in a factor analysis that has a single factor solution. The category of care scales were used to construct a summated composite scale which exhibits strong evidence of internal consistency (alpha= 0.90). External validity of the composite quality scale was checked by regressing the composite scale on Consumer Assessment of Healthcare Providers and Systems (CAHPS) survey results for 1999.</p>","PeriodicalId":55071,"journal":{"name":"Health Care Financing Review","volume":"28 3","pages":"95-107"},"PeriodicalIF":0.0,"publicationDate":"2007-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4194991/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"26841980","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Partially capitated managed care versus FFS for special needs children. 部分资金管理式护理与特殊需要儿童的FFS。
Health Care Financing Review Pub Date : 2007-01-01
Cynthia R Schuster, Jean M Mitchell, Darrell J Gaskin
{"title":"Partially capitated managed care versus FFS for special needs children.","authors":"Cynthia R Schuster,&nbsp;Jean M Mitchell,&nbsp;Darrell J Gaskin","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>Little research has examined whether Medicaid managed care plans (MCPs) that incorporate case management are effective in coordinating services for children with special health care needs (CSHCN). This study evaluates the effects of enrollment of special needs children into a partially capitated MCP (with ongoing case management) versus the fee-for-service (FFS) option on use of therapeutic services, specifically speech, occupational, and physical therapy by site of service (school versus health care sector). Results show that special needs children enrolled in the partially capitated MCP are significantly more likely to obtain occupational and physical therapy at school relative to their FFS counterparts. Moreover, children enrolled in FFS are significantly less likely to be either regular or frequent users of each type of therapy relative to children enrolled in managed care. We attribute much of these disparities in use of therapeutic services at school to the availability of case management and coordination that is an integral component of the partially capitated MCP.</p>","PeriodicalId":55071,"journal":{"name":"Health Care Financing Review","volume":"28 4","pages":"109-23"},"PeriodicalIF":0.0,"publicationDate":"2007-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4195005/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"26909869","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
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