Testing the Effect of Quality Reports on the Health Plan Choices of Medicare Beneficiaries

2002 ◽  
Vol 39 (4) ◽  
pp. 355-371 ◽  
Author(s):  
Jennifer D. Uhrig ◽  
Pamela Farley Short
Keyword(s):  
Laboratory Experiment ◽  
Health Plan ◽  
Low Cost ◽  
Health Maintenance Organization ◽  
Quality Information ◽  
Medicare Beneficiaries ◽  
Convenience Sample ◽  
Health Maintenance ◽  
Plan Choice ◽  
Quality Reports

This article describes a laboratory experiment that used a convenience sample of 225 Medicare beneficiaries to test the effects of comparative quality information on plan choice. Providing information about quality did not significantly influence the choice between Original Medicare and a health maintenance organization (HMO), but did affect the choice of HMO. Results from this experiment suggest that information about plan quality may not be effective in encouraging beneficiaries to leave Original Medicare and join HMOs that are rated high in quality. Furthermore, beneficiaries choosing among HMOs were not inclined to select a low-cost HMO, even when it was rated higher in quality. Implications for policy are discussed.

Appeals Court Rejects Federal Jurisdiction over Chiropractors Challenge to Medicare Coverage – Am. Chiropractic Ass'n, Inc. v. Leavitt

2006 ◽  
Vol 34 (2) ◽  
pp. 472-474 ◽  
Author(s):  
Carmen E. Lewis
Keyword(s):  
Health Maintenance Organization ◽  
The United States ◽  
Disabled Persons ◽  
District Court ◽  
Medicare Beneficiaries ◽  
Health Maintenance ◽  
Court Of Appeals ◽  
Medicare Program ◽  
Federal Jurisdiction ◽  
Appeals Court

The United States Court of Appeals for the District of Columbia Circuit (“Appeals Court”) held that the district court did not have jurisdiction over the American Chiropractor's Association's (“ACA”) federal question claims brought under the Medicare Act, despite affirming the ACA's prudential standing to pursue its claims. The Appeals Court reversed the lower court's decision allowing a doctor of medicine or osteopathy to perform manual manipulations of the spine on Medicare beneficiaries to correct a subluxation.The Medicare program “subsidizes medical insurance for elderly and disabled persons.” An enrollee selects a physician or obtains medical services through a managed-care provider, such as a health maintenance organization (“HMO”).

scholarly journals Do health-related feared possible selves motivate healthy eating?

2014 ◽  
Vol 2 (1) ◽  
Author(s):  
Samar Noureddine ◽  
Bonnie Metzger
Keyword(s):  
Healthy Eating ◽  
Self Efficacy ◽  
Possible Selves ◽  
Eating Habits ◽  
Health Maintenance Organization ◽  
Convenience Sample ◽  
Health Maintenance ◽  
Healthy Eating Habits ◽  
Health Related ◽  
Descriptive Survey

The question of what motivates individuals to assume healthy eating habits remains unanswered. The purpose of this descriptive survey is to explore health-related feared possible selves in relation to dietary beliefs and behavior in adults. A convenience sample of 74 middle-aged employees of a health maintenance organization completed self-administered questionnaires. Health-related feared selves, current health perception, knowledge of diet-health association, dietary self-efficacy, dietary intention and intake were measured. Health-related fears were the most frequently reported feared selves, but very few of those represented illnesses and none were related to dietary intake. The number of health and body weight related fears was significantly associated with lower dietary self-efficacy and weaker intention to eat in a healthy manner. Multivariate analysis showed self-efficacy to be the only significant predictor of dietary intention. These adults may not have perceived being at risk for diet-associated illnesses, and so their feared selves did not motivate them to eat in a healthy manner. Research on the effect of hoped for health related possible selves and the perceived effectiveness of diet in reducing health risk are recommended.

Would Better Adherence to Guidelines Improve Childhood Immunization Rates?

PEDIATRICS ◽  
1996 ◽  
Vol 98 (6) ◽  
pp. 1062-1068
Author(s):  
Tracy A. Lieu ◽  
Steven B. Black ◽  
Michael E. Sorel ◽  
Paula Ray ◽  
Henry R. Shinefield
Keyword(s):  
Health Plan ◽  
Chart Review ◽  
Tracking System ◽  
Insurance Coverage ◽  
Health Maintenance Organization ◽  
Clinic Visit ◽  
Simultaneous Administration ◽  
Health Maintenance ◽  
Provider Practices ◽  
Second Year

Objective. To evaluate the contribution of three provider practices to underimmunization of children with financial coverage for vaccines. Design. Retrospective cohort study of children in a large health maintenance organization, based on computerized databases and chart review. Setting. Large health maintenance organization in northern California. Patients. The population included 24 268 children who had at least one immunization recorded in the health plan tracking system and had continuous health plan membership between 15 and 24 months of age in 1992 through 1993. The study group (N = 4691) were those who had missed one or more of the immunizations due during their second year. Results. Most (57%) of the underimmunized children had made at least one clinic visit between 15 and 24 months of age. Among those underimmunized children who made well care visits, 90% had been partially immunized at the visit but had not been simultaneously given all vaccines for which they were eligible. When a provider did not give all possible vaccines simultaneously, there was a 9% chance that the child would go on to miss the remaining immunization. Simultaneous administration alone would have achieved full second year coverage of 30% of the underimmunized children in this population. Most underimmunized children (53%), including 35% of those children who had not made any well care visits, had made urgent visits between 15 and 24 months of age. Chart review of randomly sampled patients showed no obstacle or contraindication to immunization at 79% of urgent visits and at 71% of well care visits at which vaccines were withheld. A policy to use weekday urgent visits to promote immunization could potentially reach 27% of the underimmunized children. Conclusions. Provider practices play an important role in underimmunization of children who have insurance coverage for vaccines. Of the three guidelines evaluated, simultaneous administration of all possible vaccines has the greatest potential effectiveness to improve coverage rates in this population. Other guidelines, such as immunizing at urgent visits, are potentially effective but their costs and logistics need further study.

Hearing Aid Health Plan Benefits–A Warning

2010 ◽  
Vol 6 (1) ◽  
pp. 33-34
Author(s):  
Steven C. White ◽  
Janet McCarty
Keyword(s):  
Health Plan ◽  
Hearing Aids ◽  
Health Maintenance Organization ◽  
Health Plans ◽  
Reimbursement Rate ◽  
Health Maintenance ◽  
Provider Organization ◽  
Preferred Provider Organization ◽  
The Cost ◽  
Managed Care Organizations

Audiologists must carefully review a contract before enrolling with a preferred provider organization (PPO) or a health maintenance organization (HMO). Although health plans have covered hearing evaluations for many years, in response to demand, more MCOs are adding hearing aids as a benefit. Audiologists should be familiar with the various approaches to deriving reimbursement from managed care organizations (MCOs) and their obligation as network providers, or they may end up losing money if the reimbursement rate is lower than the cost of the dispensed product(s) and services that are provided.

Identifying Health Maintenance Organization Membership Through Self-report of Health Plan Name

2006 ◽  
Vol 12 (3) ◽  
pp. 278-287 ◽  
Author(s):  
Karen M. Clements ◽  
Bruce B. Cohen ◽  
Phyllis Brawarsky ◽  
Daniel R. Brooks ◽  
Lorelei A. Mucci ◽  
...  
Keyword(s):  
Health Plan ◽  
Health Maintenance Organization ◽  
Self Report ◽  
Health Maintenance ◽  
Organization Membership

scholarly journals Medicare Advantage Enrollment and Beneficiary Risk Scores: Difference-in-Differences Analyses Show Increases for All Enrollees On Account of Market-Wide Changes

2018 ◽  
Vol 55 ◽  
pp. 004695801878864
Author(s):  
Tamara Beth Hayford ◽  
Alice Levy Burns
Keyword(s):  
Health Maintenance Organization ◽  
Risk Scores ◽  
Intensity Difference ◽  
Fee For Service ◽  
Medicare Advantage ◽  
Medicare Beneficiaries ◽  
Difference In Differences ◽  
Health Maintenance ◽  
Duration Effect ◽  
The Relationship

Medicare adjusts payments to Medicare Advantage (MA) insurers using risk scores that summarize the relationship between fee-for-service (FFS) Medicare spending and beneficiaries’ demographic characteristics and documented health conditions. Research shows that MA insurers have increasingly documented conditions more thoroughly than traditional Medicare—resulting in higher payments to insurers—but little is known about what factors contribute to diverging risk scores. We apportion that divergence between market-wide increases and increases that vary with length of MA enrollment. We also examine whether effects vary across plan types and whether the enrollment duration effect is contingent upon remaining with the same insurer. Using Medicare administrative data from 2008 to 2013, we employ a difference-in-differences model to compare the growth in risk scores of Medicare beneficiaries who switch from FFS to MA to that of beneficiaries who remain in FFS. We find that the effect of MA enrollment on risk scores increased from 5% in 2009 to 8% in 2012 and that continuous enrollment in MA was associated with an additional 1.2% increase per year, regardless of continuous enrollment with an insurer. Thus, even among those who switched to MA in 2009, enrollment duration comprised less than one-third of the coding intensity difference in 2012. We also find that risk scores grew faster in areas with greater MA penetration and among Health Maintenance Organization enrollees. Overall, our findings suggest that market-wide factors contributed most to the increasing divergence between FFS and MA risk scores.

Family Health Plan Choices: The Health Maintenance Organization Option

1985 ◽  
Vol 34 (1) ◽  
pp. 71 ◽  
Author(s):  
Pamela A. Monroe ◽  
James C. Garand ◽  
Sharon J. Price
Keyword(s):  
Health Plan ◽  
Health Maintenance Organization ◽  
Family Health ◽  
Health Maintenance
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