Are Managed Care Plans Organizing for Quality?

2000 ◽  
Vol 57 (3 suppl) ◽  
pp. 9-32 ◽  
Author(s):  
D. P. Scanlon ◽  
E. Rolph ◽  
C. Darby ◽  
H. E. Doty
Keyword(s):  
2021 ◽  
pp. 107755872110189
Author(s):  
Laura M. Keohane ◽  
Zilu Zhou ◽  
David G. Stevenson

To coordinate Medicare and Medicaid benefits, multiple states are creating opportunities for dual-eligible beneficiaries to join Medicare Advantage Dual-Eligible Special Needs Plans (D-SNPs) and Medicaid plans operated by the same insurer. Tennessee implemented this approach by requiring insurers who offered Medicaid plans to also offer a D-SNP by 2015. Tennessee’s aligned D-SNP participation increased from 7% to 24% of dual-eligible beneficiaries aged 65 years and above between 2011 and 2017. Within a county, a 10-percentage-point increase in aligned D-SNP participation was associated with 0.3 fewer inpatient admissions ( p = .048), 13.9 fewer prescription drugs per month ( p = .048), and 0.3 fewer nursing home users ( p = .06) per 100 dual-eligible beneficiaries aged 65 years and older. Increased aligned plan participation was associated with 0.2 more inpatient admissions ( p = .004) per 100 dual-eligible beneficiaries younger than 65 years. For some dual-eligible beneficiaries, increasing Medicare and Medicaid managed plan alignment has the potential to promote more efficient service use.


PEDIATRICS ◽  
1992 ◽  
Vol 90 (2) ◽  
pp. 278-279
Author(s):  
JENIFER D. C. CARTLAND ◽  
BETH K. YUDKOWSKY

In Reply.— Doctors Sapin and Laws raise fundamental concerns about our article that was recently published in Pediatrics.1 We feel that these concerns are addressed adequately in the paper, but we would like to take this opportunity to clarify our findings. Dr Sapin argues that our study characterizes all managed care plans, such as the Kaiser Permanente Medical Care Program in which he practices, as having ineffective referral mechanisms. He holds that pediatricians at Kaiser experience "no barriers to appropriate referrals" and indicates that we did not stress this finding adequately.


1995 ◽  
Vol 333 (25) ◽  
pp. 1678-1683 ◽  
Author(s):  
Marsha R. Gold ◽  
Robert Hurley ◽  
Timothy Lake ◽  
Todd Ensor ◽  
Robert Berenson

1994 ◽  
Vol 3 (4) ◽  
pp. 189-194 ◽  
Author(s):  
Suzanna Kingsland ◽  
Penny Smith ◽  
Sharon McKinley

2020 ◽  
Vol 59 (4) ◽  
pp. 593-596
Author(s):  
Sara B. McMenamin ◽  
Sara W. Yoeun ◽  
Joanne P. Wellman ◽  
Shu-Hong Zhu

2004 ◽  
Vol 37 (2) ◽  
pp. 129-142 ◽  
Author(s):  
AMARDEEP THIND

Respiratory illness continues to be a leading cause of paediatric morbidity and mortality in Indonesia. The Indonesian government is moving towards a more managed care-based approach as it reforms its health care system following the 1997 financial crisis. In order to better design contractual relationships between the payor and different providers, there needs to be a better understanding of the patterns and predictors of health services utilization for respiratory illness. This study uses the Indonesia Demographic and Health Survey to study the determinants of private, public and non-formal provider utilization for respiratory illness. Multinomial logistic regression models for predicting use were constructed using the Andersen Behavioural Model as the conceptual framework. The findings indicate that age, household size, maternal education, religion, the asset index, location and illness severity play a role in determining use of private, public or non-formal providers. The results indicate that from a policy perspective, the Indonesian government needs be inclusive rather than exclusive in the choice of providers that are contracted by the managed care plans, in order to safeguard the health of the under-five population.


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