Plan Choice and Changes in Access to Care over Time for SSI-Eligible Children with Disabilities

2005 ◽  
Vol 42 (2) ◽  
pp. 145-159 ◽  
Author(s):  
Pamela N. Roberto ◽  
Jean M. Mitchell ◽  
Darrell J. Gaskin
Keyword(s):  
Managed Care ◽  
Access To Care ◽  
Estimation Procedure ◽  
Care Plan ◽  
Care Hospital ◽  
Fee For Service ◽  
Special Needs Children ◽  
Plan Choice ◽  
Two Step Estimation ◽  
Over Time

This paper analyzes how voluntary enrollment in the fee-for-service (FFS) system versus a partially capitated managed care plan affects changes in access to care over time for special needs children who receive Supplemental Security Income (SSI) due to a disability. Four indicators of access are evaluated, including specialty care, hospital care, emergency care, and access to a regular doctor. We employ the Heckman two-step estimation procedure to correct for the potential nonrandom selection bias linked to plan choice. The findings show that relative to their counterparts in the partially capitated managed care plan, SSI children enrolled in the FFS plan are significantly more likely to encounter an access problem during either of the time periods studied. Similarly, FFS enrollees are significantly more likely than partially capitated managed care participants to experience persistent access problems across three of the four dimensions of care. Possible explanations for the deterioration in access associated with FFS include the lack of case management services, lower reimbursement relative to the partially capitated managed care plan, and provider availability.

Does Managed Care Improve Access to Care for Medicaid Beneficiaries with Disabilities? A National Study

2008 ◽  
Vol 45 (4) ◽  
pp. 395-407 ◽  
Author(s):  
Teresa A. Coughlin ◽  
Sharon K. Long ◽  
John A. Graves
Keyword(s):  
Managed Care ◽  
Access To Care ◽  
Rural Areas ◽  
Urban Areas ◽  
Control Program ◽  
National Study ◽  
Fee For Service ◽  
Pooled Data ◽  
Medicaid Beneficiaries ◽  
Program Costs

States increasingly are shifting Medicaid beneficiaries with disabilities from the fee-for-service (FFS) delivery system to managed care in an effort to control program costs and address long-standing problems with access to care under the program. Using a county-based measure of managed care enrollment and pooled data from the 1997 to 2004 National Health Interview Surveys, we investigate whether Medicaid managed care (MMC), relative to FFS Medicaid, improves access to care. We find some evidence of improved access to care under MMC; however, the gains appear to be largely limited to beneficiaries in urban areas with fully capitated managed care. There is little evidence of improved access under primary care case management or, regardless of MMC type, in rural areas.

Incidence, annualized cost, and utilization burden in patients with metastatic renal cell carcinoma

2009 ◽  
Vol 27 (15_suppl) ◽  
pp. e17529-e17529
Author(s):  
J. P. Burke ◽  
Z. Liu ◽  
J. Zheng ◽  
J. Johnson
Keyword(s):  
Health Care ◽  
Renal Cell Carcinoma ◽  
Managed Care ◽  
Health Care Utilization ◽  
Cell Carcinoma ◽  
Renal Cell ◽  
Care Plan ◽  
Care Utilization ◽  
Newly Diagnosed ◽  
Over Time

e17529 Background: Data on burden of metastatic renal cell carcinoma (MRCC) is scarce. The objectives of this study are to examine the incidence of MRCC and the cost and utilization burden of MRCC over time. Methods: Administrative claims data from a large, US managed care plan were used to identify commercially insured and Medicare enrollees with newly diagnosed MRCC during 01/01/03–12/31/07 and continuous enrollment 12 months prior to and at least 90 days after MRCC diagnosis. Mean (median) costs and utilization during the follow-up period were annualized. Costs were 2007 CPI-adjusted. Results: 1,427 patients were identified with newly diagnosed MRCC (average age: 62.4 years 62.6% male). The annual incidence of MRCC in the managed care plan population was 3.4, 3.8, 2.9, 3.3, and 4.4 per 100,000 enrollees in 2003 through 2007, respectively. The mean (median) annual number of ambulatory visits per patient increased among patients diagnosed in 2003 to those diagnosed in 2007, from 44.9 (33.2) to 63.7 (54.8). Mean (median) annual medical costs per patient increased by year of diagnosis from $70,797 ($33,031) in 2003 to $92,521 ($48,117) in 2007. Pharmacy costs (excluding costs for medications delivered in medical settings) increased from $5,651 ($2,004) to $13,290 ($3,609), and were approximately 7.4%-14.3% of total costs during the time period. Conclusions: This study showed an apparent slight increase in MRCC incidence rates and revealed that treatment costs and health care utilization per patient increased substantially from 2003–2007 among members of this US managed care plan. The increases in health care utilization and cost suggest the evolution in treatment options over time as more therapies become available. No significant financial relationships to disclose.

scholarly journals Effectiveness of Standard Oral Care Plan During Hospital Stay in Individuals With Brain Injury

2021 ◽  
Vol 12 ◽  
Author(s):  
Simple F. Kothari ◽  
Gustavo G. Nascimento ◽  
Mille B. Jakobsen ◽  
Jørgen F. Nielsen ◽  
Mohit Kothari
Keyword(s):  
Brain Injury ◽  
Oral Health ◽  
Dental Plaque ◽  
Oral Care ◽  
Care Program ◽  
Care Plan ◽  
Multilevel Regression ◽  
Early Introduction ◽  
Brain Injured ◽  
Over Time

Objective: To investigate the effectiveness of an existing standard oral care program (SOCP) and factors associated with it during hospitalization in individuals with acquired brain injury (ABI).Material and Methods: A total of 61 individuals underwent a SOCP for 4 weeks in a longitudinal observational study. Rapidly noticeable changes in oral health were evaluated by performing plaque, calculus, bleeding on probing (BOP) and bedside oral examination (BOE) at weeks 1 and 5. Individuals' brushing habits, eating difficulties, and the onset of pneumonia were retrieved from their medical records. Association between oral-health outcomes to systemic variables were investigated through multilevel regression models.Results: Dental plaque (P = 0.01) and total BOE score (P < 0.05) decreased over time but not the proportion of dental calculus (P = 0.30), BOP (P = 0.06), and tooth brushing frequency (P = 0.06). Reduction in plaque and BOE over time were negatively associated with higher periodontitis scores at baseline (coef. −6.8; −1.0), respectively, which in turn were associated with an increased proportion of BOP (coef. ≈ 15.0). An increased proportion of calculus was associated with eating difficulties (coef. 2.3) and the onset of pneumonia (coef. 6.2).Conclusions: Nursing care has been fundamental in improving oral health, especially reducing dental plaque and BOE scores. However, our findings indicate a need for improving the existing SOCP through academic-clinical partnerships.Clinical Relevance: Early introduction of oral care program to brain-injured individuals is beneficial in reducing plaque accumulation and improving oral health.

"DR UNNECESSARY"

PEDIATRICS ◽  
1996 ◽  
Vol 97 (2) ◽  
pp. A30-A30
Author(s):  
J. F. L.
Keyword(s):  
Managed Care ◽  
Private Practice ◽  
Psychiatric Treatment ◽  
Health Maintenance Organizations ◽  
Case Managers ◽  
Fee For Service ◽  
Health Maintenance ◽  
Insurance Costs ◽  
Treatment Plans

The old reality for many psychiatrists was a private practice filled with long-term patients who paid $100 or more for 50 minutes of talk. The new reality? Managing medication for up to 30 new patients a week for half the hourly fee—and answering to case managers who aren't even doctors. No wonder the number of U.S. medical school graduates in psychiatric residencies dropped nearly 12%—to 3909 from 4447—between 1988 and 1994. The blame—or the credit—goes to managed care, the catchall term for the revolution that has swept through both the medical and mental health care fields in recent years. Desperate to cut runaway health insurance costs, most companies have axed longstanding fee-for-service plans and instead steer employees seeking psychiatric treatment to health maintenance organizations or specialized managed-care firms. These organizations decide the type and amount of care patients receive. Psychiatrists have to get with the program—and agree to its treatment plans and fee schedules—or watch the bulk of their practices disappear. Only the rare psychiatrist can attract private patients wealthy enough to pay for traditional psychotherapy without the benefit of insurance.

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