Predictive Modelling and Mind-Set Segments Underlying Health Plans

2017 ◽  
pp. 135-156 ◽  
Author(s):  
Gillie Gabay ◽  
Howard Moskowitz ◽  
Steven Onufrey ◽  
Stephen Rappaport
Keyword(s):  
Health Promotion ◽  
Health Systems ◽  
Preventive Medicine ◽  
Predictive Analytics ◽  
Predictive Modelling ◽  
Health Maintenance Organizations ◽  
Health Plans ◽  
Health Maintenance ◽  
The World ◽  
Mind Set

Health systems are facing austerity negatively affecting the delivery of services around the world. This chapter defines predictive analytics in health, discusses how predictive analytics may contribute to health promotion and demonstrates the identification of specific communication elements to be used by health maintenance organizations and insurers to shape health plans in accordance to mind-set segments of patients. Although the application of predictive analytics to health plans may reduce costs and shift the focus of health systems from treating the sick to preventive medicine, it has not been investigated and is the topic of this chapter.

"DOCTORS SAY HMOs RESTRICT OPEN DISCUSSION OF PATIENT CARE AND PAYMENT POLICIES" "DOCTORS SAY HMOs LIMIT WHAT THEY CAN TELL PATIENTS"

PEDIATRICS ◽  
1996 ◽  
Vol 97 (2) ◽  
pp. A30-A30
Author(s):  
J. F. L.
Keyword(s):  
Patient Care ◽  
Treatment Options ◽  
Health Maintenance Organizations ◽  
Health Plans ◽  
Health Maintenance ◽  
The World ◽  
Legal Duty ◽  
Open Discussion ◽  
Payment Policies

Doctors across the country say that health maintenance organizations (HMOs) routinely limit their ability to talk freely with patients about treatment options and HMO payment policies, including financial bonuses for doctors who save money by withholding care. In interviews over the last 3 weeks, many doctors said such restrictions interfered with their ethical and legal duty to provide patients with information about the benefits, risks, and costs of various treatments. Ill feeling over the restrictions is growing as more and more Americans join HMOs and employers encourage their use to control costs. The doctors' complaints illustrate the tension between them and HMOs as health plans try to monitor and regulate the doctors' behavior. Dr Daniel A Gregorie, president of Choice Care in Cincinnati, defended the confidentiality clause as a way to prevent doctors from sharing their frustrations with patients. "Physicians are angry, frustrated and, to some extent, depressed because the world as they've known it is changing rapidly and radically," Dr Gregorie said. "But physicians should not take out that frustration in a nonconstructive way by sharing it with patients. That does not help the patients. It just makes them more anxious about the care they are receiving."

Health Maintenance Organizations/Health Plans

2012 ◽  
pp. 163-188 ◽  
Author(s):  
Susan E. Andrade ◽  
Marsha A. Raebel ◽  
Denise Boudreau ◽  
Robert L. Davis ◽  
Katherine Haffenreffer ◽  
...  
Keyword(s):  
Health Maintenance Organizations ◽  
Health Plans ◽  
Health Maintenance

Do HMO Members Get More Cancer Checkups?

1988 ◽  
Vol 7 (1) ◽  
pp. 219-231
Author(s):  
Betsy D. Gelb ◽  
Marilyn Y. Jones ◽  
Sandra S. Person
Keyword(s):  
Health Plan ◽  
Preventive Medicine ◽  
Insurance Coverage ◽  
Health Maintenance Organizations ◽  
Health Maintenance ◽  
To Receive ◽  
Age Category

One justification for Congressional support of Health Maintenance Organizations has been the supposition that they promote preventive medicine. This study found HMO members no more likely overall to receive appropriate cancer checkups than individuals with traditional (reimbursement) insurance coverage, although in the under-40 age category, HMO members were more likely to receive the checkups. The study identified reminders, rather than type of health plan coverage, as the key predictor of obtaining checkups.

scholarly journals Universal health coverage and COVID-19: recent developments and implications

2021 ◽  
Vol 14 (1) ◽  
Author(s):  
Rabia Hussain ◽  
Sara Arif
Keyword(s):  
Health Promotion ◽  
Health Systems ◽  
Universal Health Coverage ◽  
Health Inequities ◽  
Healthcare Systems ◽  
Health Coverage ◽  
Developed Economies ◽  
The World ◽  
Recent Developments ◽  
Universal Health

AbstractUniversal health coverage (UHC) is meant to access the key health services including disease prevention, treatment, rehabilitation, and health promotion. UHC varies according to demographics, epidemiology, and technology-based trends, as well as according to people’s expectations. Globally, the transition towards UHC has been associated with the intent of improving accessibility and affordability of healthcare. The COVID-19 pandemic has disrupted the health systems of even the most developed economies of the world in an unprecedented manner. The situation is also very challenging for the countries with the existing health inequities as well as the countries with the developing healthcare systems. This has amplified the need to accelerate efforts to build strong and resilient health systems to achieve progress towards UHC. This commentary discusses a global overview of UHC in the wake of COVID19. It also highlights the initiatives taken by Pakistan to promote the goals of UHC.

PEOPLE WANT MORE INFORMATION FOR HEALTH CHOICES, SURVEY FINDS

PEDIATRICS ◽  
1995 ◽  
Vol 96 (5) ◽  
pp. A45-A45
Author(s):  
J. F. L.
Keyword(s):  
Telephone Survey ◽  
Health Maintenance Organizations ◽  
Report Cards ◽  
Health Plans ◽  
Health Maintenance ◽  
Care Plans ◽  
Percentage Points ◽  
Margin Of Error ◽  
Consumer Ratings ◽  
Health Choices

Most people would like to have more information to help them choose hospitals, doctors, and health care plans, a new survey by Louis Harris and Associates has found. Many large employers already receive reports from health maintenance organizations and other health plans on how satisfied their members are. Many employers and health plans also collect appraisals of doctors and hospitals by patients. But such reports are not often shown to the consumers themselves, company benefits executives say. In the Harris survey, which was commissioned by Towers Perrin, a benefits consulting firm, 66% said they would like to see report cards for hospitals, 58% said they would like to see consumer ratings of physicians, and 52% wanted ratings for health plans. The telephone survey of 1081 people was weighted to reflect all United States heads of households or spouses age 21 or older. The margin of error was plus or minus 3 percentage points. Most were employees of large companies, which other surveys have shown are most likely to offer choices of health plans.

Kentucky Association of Health Plans, Inc. v. Miller

2003 ◽  
Vol 31 (4) ◽  
pp. 729-731 ◽  
Author(s):  
Valerie Gutmann
Keyword(s):  
Supreme Court ◽  
Insurance Industry ◽  
Health Maintenance Organizations ◽  
Health Plans ◽  
Retirement Income ◽  
Court System ◽  
Health Maintenance ◽  
Income Security ◽  
The Supreme Court ◽  
Retirement Income Security

In Kentucky Association of Health Plans, Inc. v. Miller,, the Supreme Court unanimously held that states’ “any willing provider” laws are not preempted by the Employee Retirement Income Security Act of 1974 (ERISA). The Court ruled that states can regulate their health maintenance organizations (HMOs), and thus upheld a Kentucky law that requires insurers to reimburse services of any health care provider who is willing and able to meet established criteria. The Supreme Court has heard several cases related to ERISA in the last few years, and other such cases are working their way through the court system. Coupled with this most recent decision in Miller, the Supreme Court may significantly alter the shape of the insurance industry.

scholarly journals Managed Care: An Industry Snapshot

2002 ◽  
Vol 39 (3) ◽  
pp. 207-220 ◽  
Author(s):  
Keyword(s):  
Primary Care ◽  
American Association ◽  
Management Strategies ◽  
Basic Structure ◽  
Health Maintenance Organizations ◽  
Care Physician ◽  
Health Plans ◽  
Fee For Service ◽  
Physician Payment ◽  
Health Maintenance

Together with the American Association of Health Plans (AAHP), we surveyed health maintenance organizations (HMOs) in 1998 to characterize their basic structure and management strategies. The findings show that more than half of HMO enrollees belong to plans that contract with primary care physician (PCP) groups on a predominantly capitated basis. Such plans tend to be larger and to contract with large physician groups. Thirty percent to 40% of enrollees are in plans that delegate utilization and network management to physician groups paid by capitation, but plans almost never delegate these functions to groups paid by fee-for-service. Plans tend to retain quality assurance functions irrespective of whether they use fee-for-service or capitation as a basis for physician payment. The autonomy of PCPs to order tests and procedures varies with the test and procedure.

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