Call Me Back: Examining Provider Biases Through Callback Rates and Responsiveness

2021 ◽  
Vol 49 (7) ◽  
pp. 958-986
Author(s):  
Wei-Chin Hwang ◽  
Courtney P. Chan ◽  
Ken A. Fujimoto
Keyword(s):  
Substance Abuse ◽  
Los Angeles ◽  
Field Experiment ◽  
Cultural Competency ◽  
Race And Ethnicity ◽  
Health Maintenance Organization ◽  
Insurance Companies ◽  
Health Maintenance ◽  
Substance Abuse Disorders ◽  
Main Effects

We conducted a phone-based field experiment to investigate the callback rate of psychologists. Providers ( N = 903) in Los Angeles, California who were selected from a health maintenance organization insurance panel list were left voicemails by actors simulating patients of various backgrounds (i.e., race, gender, clinical diagnosis, and ethnic distinctiveness of name). Findings indicated that 71.5% of providers did not return calls to prospective patients. There were no main effects of race and ethnicity on callback. However, ethnic distinctiveness of name moderated the effects of diagnosis. Providers were more responsive to depressed patients with ethnic names, but less responsive to patients with ethnic names and personality or substance abuse disorders. These findings are important because unresponsive providers and insurance companies that do not provide up-to-date panel listings can act as barriers to care, which can have deleterious consequences for help-seekers. Advocacy recommendations and the importance of cultural competency are highlighted.

Using decision analysis to select alternate modes of dispensing: An example from Los Angeles County Public Health

2009 ◽  
Vol 7 (2) ◽  
pp. 39
Author(s):  
Sinan Khan, MPH, MA ◽  
Anke Richter, PhD
Keyword(s):  
Public Health ◽  
Los Angeles ◽  
Decision Analysis ◽  
Los Angeles County ◽  
Relative Effectiveness ◽  
Health Maintenance Organization ◽  
Sensitivity Analyses ◽  
Health Maintenance ◽  
Response Planning ◽  
The Many

Objective: To comply with the Center for Disease Control’s mass prophylaxis mandates, many public health jurisdictions must supplement their existing Points of Dispensing (POD)-based system. Because of limited budgets and personnel availability, only one or two alternatives out of the many potential options can be implemented.Design: Multicriteria decision analysis is a powerful tool that allows public health officials to assess the relative effectiveness of alternate modes of dispensing while incorporating the opinions of their multidisciplinary emergency response planning teams.Setting: This process was utilized to analyze the effectiveness of alternate modes of dispensing that could be used to supplement the existing POD system within the Los Angeles County (LAC) Department of Public Health (DPH).Results: The top two options for LAC were prepositioning for civil service and partnership with a major Health Maintenance Organization. These choices were stable under a variety of sensitivity analyses, and the differences in opinion between the agencies and other stakeholders do not change them.Conclusions: The transparency of the model and analysis may allow decision makers and planners in the LAC DPH to garner support for their alternate modes of dispensing plans. By making the decision criteria clear and demonstrating the robustness of the results in the sensitivity analyses, public health partners gain a deeper understanding of the issues and their potential roles. The process can be repeated by any jurisdiction, but definition of “best” will rely on the issues and gaps that are identified with the jurisdiction’s POD plan for mass prophylaxis.

Substance Abuse Treatment Processes and Outcomes in Day/Outpatient Health Maintenance Organization Setting

2014 ◽  
Vol 25 (3) ◽  
pp. 130-136 ◽  
Author(s):  
Donna K. McNeese-Smith ◽  
Clare L. Faivre ◽  
Cynthia Grauvogl ◽  
Nipa Umme Shefa Warda ◽  
Marc A. Kurzbard
Keyword(s):  
Substance Abuse ◽  
Substance Abuse Treatment ◽  
Health Maintenance Organization ◽  
Health Maintenance ◽  
Treatment Processes ◽  
Abuse Treatment

scholarly journals Sociodemographic changes over 25 years of pediatric epilepsy surgery at UCLA

2013 ◽  
Vol 11 (3) ◽  
pp. 250-255 ◽  
Author(s):  
Jason S. Hauptman ◽  
Andrew Dadour ◽  
Taemin Oh ◽  
Christine B. Baca ◽  
Barbara G. Vickrey ◽  
...  
Keyword(s):  
Los Angeles ◽  
Epilepsy Surgery ◽  
Low Income ◽  
Southern California ◽  
Insurance Companies ◽  
Pediatric Epilepsy ◽  
Seizure Onset ◽  
Health Maintenance ◽  
Number Of Patients ◽  
Pediatric Epilepsy Surgery

Object Low income, government insurance, and minority status are associated with delayed treatment for neurosurgery patients. Less is known about the influence of referral location and how socioeconomic factors and referral patterns evolve over time. For pediatric epilepsy surgery patients at the University of California, Los Angeles (UCLA), this study determined how referral location and sociodemographic features have evolved over 25 years. Methods Children undergoing epilepsy neurosurgery at UCLA (453 patients) were classified by location of residence and compared with clinical epilepsy and sociodemographic factors. Results From 1986 to 2010, referrals from Southern California increased (+33%) and referrals from outside of California decreased (−19%). Over the same period, the number of patients with preferred provider organization (PPO) and health maintenance organization (HMO) insurance increased (+148% and +69%, respectively) and indemnity insurance decreased (−96%). Likewise, the number of Hispanics (+117%) and Asians (100%) increased and Caucasians/whites decreased (−24%). The number of insurance companies decreased from 52 carriers per 100 surgical patients in 1986–1990 to 19 per 100 in 2006–2010. Patients living in the Eastern US had a younger age at surgery (−46%), shorter intervals from seizure onset to referral for evaluation (−28%) and from presurgical evaluation to surgery (−61%) compared with patients from Southern California. The interval from seizure onset to evaluation was shorter (−33%) for patients from Los Angeles County compared with those living in non-California Western US states. Conclusions Referral locations evolved over 25 years at UCLA, with more cases coming from local regions; the percentage of minority patients also increased. The interval from seizures onset to surgery was shortest for patients living farthest from UCLA but still within the US. Geographic location and race/ethnicity was not associated with differences in becoming seizure free after epilepsy surgery in children.

A Joint Demonstration Project to Improve the Care of Patients with Dementia: A Partnership Between a Staff Model HMO and the Alzheimer's Association

1998 ◽  
Vol 20 (2) ◽  
pp. 17-18 ◽  
Author(s):  
Dana Baldwin
Keyword(s):  
Los Angeles ◽  
Survey Methods ◽  
Care Service ◽  
Health Care Service ◽  
Health Maintenance Organization ◽  
Demonstration Project ◽  
Rand Corporation ◽  
Health Maintenance ◽  
Care Givers ◽  
Track Record

I am part of a multi-disciplinary team composed of researchers from Kaiser Permanente, the country's largest staff model Health Maintenance Organization (HMO) and the Los Angeles chapter of the Alzheimer's Disease and Related Disorders Association. This team has designed a demonstration service delivery system to enhance the quality of care given to dementia patients and their care givers. If the demonstration project is successful, it may be expanded throughout the Kaiser system. After completing my Ph.D. in medical anthropology at UCLA, I worked as a consultant at the Rand Corporation then held a post-doctoral fellowship in addictions through the National Institute on Drug Addiction. With this track record, and my experience with both qualitative and quantitative survey methods, I was hired at Kaiser as an internal health care service and organizational researcher. They did not hire me because I was an anthropologist. As an anthropologist, however, I have brought some of the discipline's perspectives to bear on the formative stages of the dementia demonstration project.

HMO and Insurance Insolvency: The Benefits and Detriments of a Federal System

1997 ◽  
Vol 23 (4) ◽  
pp. 487-509
Author(s):  
Craig P. Druehl
Keyword(s):  
House Of Representatives ◽  
Financial Risk ◽  
Health Maintenance Organization ◽  
Insurance Companies ◽  
Federal System ◽  
Regulatory Structure ◽  
Health Maintenance ◽  
Regional Markets ◽  
The U.S ◽  
Insurance Insolvency

Accompanying its expansive growth over the last fifteen years, the health maintenance organization (HMO) industry transformed from collections of HMOs in local markets into an increasingly national system under the control of centralized corporations. During that time, HMOs established national chains in an effort to capture market share. The move toward nationalization of the HMO industry suggests the need for a critical analysis of the current HMO regulatory structure to determine whether it effectively safeguards the proper functioning of HMOs. As national and regional HMOs compete among themselves and with local HMOs, the need for unified, consistent financial protections with respect to HMOs and similar entities becomes acute. Competition from national HMOs creates increased financial risk for the smaller HMOs whose regional markets were previously insulated from broad-based competition. The need for preventative rules to offset this added risk, as well as a means by which to adjudicate consistently cases of HMO and insurance insolvency, became sufficiently acute that in March 1993 the U.S. House of Representatives sought to regulate federally the solvency of insurance companies by proposing a Federal Insurance Solvency Commission. In addition, to deal effectively with these problems, various industry participants and regulatory entities currently seek other remedies and attempt action of varying degrees.

Substance Abuse Treatment Duration for Medicaid Versus Commercial Clients in a Health Maintenance Organization

Medical Care ◽  
2006 ◽  
Vol 44 (6) ◽  
pp. 601-606 ◽  
Author(s):  
Bentson H. McFarland ◽  
Frances L. Lynch ◽  
Donald K. Freeborn ◽  
Carla A. Green ◽  
Michael R. Polen ◽  
...  
Keyword(s):  
Substance Abuse ◽  
Substance Abuse Treatment ◽  
Treatment Duration ◽  
Health Maintenance Organization ◽  
Health Maintenance ◽  
Abuse Treatment

Substance Abuse in Older Psychiatric Inpatients

2017 ◽  
Vol 63 (2) ◽  
pp. 115-121 ◽  
Author(s):  
Tilman Wetterling ◽  
Klaus Junghanns
Keyword(s):  
Substance Abuse ◽  
Substance Abusers ◽  
Psychiatric Inpatient ◽  
Psychiatric Inpatients ◽  
Severe Withdrawal ◽  
Psychiatric Inpatient Treatment ◽  
Clinical Diagnoses ◽  
Multiple Substance ◽  
Icd 10 ◽  
Substance Abuse Disorders

Abstract. Aim: This study investigates the characteristics of older patients with substance abuse disorders admitted to a psychiatric department serving about 250.000 inhabitants. Methods: The clinical diagnoses were made according to ICD-10. The data of the patients with substance abuse were compared to a matched sample of psychiatric inpatients without substance abuse as well as to a group of former substance abusers with long-term abstinence. Results: 19.3 % of the 941 patients aged > 65 years showed current substance abuse, 9.4 % consumed alcohol, 7.9 % took benzodiazepines or z-drugs (zolpidem and zopiclone), and 7.0 % smoked tobacco. Multiple substance abuse was rather common (30.8 %). About 85 % of the substance abusers had psychiatric comorbidity, and about 30 % showed severe withdrawal symptoms. As with the rest of the patients, somatic multimorbidity was present in about 70 % of the substance abusers. Remarkable was the lower rate of dementia in current substance abusers. Conclusion: These results underscore that substance abuse is still a challenge in the psychiatric inpatient treatment of older people.

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