scholarly journals Developing Efficient Managed Care programs for the Chronically Ill – Ethic, Economic, Legal and Social Aspects

2013 ◽  
Vol 13 (5) ◽  
Author(s):  
Sarah Mostardt ◽  
Lennart Weegen ◽  
Lasse Korff ◽  
Sonja Ivancevic ◽  
Anke Walendzik ◽  
...  
Keyword(s):  
Managed Care ◽  
Chronically Ill ◽  
Social Aspects ◽  
Managed Care Programs

scholarly journals Medicaid Managed Care's Effects on Costs, Access, and Quality: An Update

2020 ◽  
Vol 41 (1) ◽  
pp. 537-549
Author(s):  
Daniela Franco Montoya ◽  
Puneet Kaur Chehal ◽  
E. Kathleen Adams
Keyword(s):  
High Risk ◽  
Managed Care ◽  
Health Maintenance Organization ◽  
Cost Savings ◽  
High Risk Population ◽  
Medicaid Managed Care ◽  
Term Care ◽  
Health Maintenance ◽  
Managed Care Programs ◽  
Access And Quality

Medicaid is integral to public health because it insures one in five Americans and half of the nation's births. Nearly two-thirds of all Medicaid recipients are currently enrolled in a health maintenance organization (HMO). Proponents of HMOs argue that they can lower costs while maintaining access and quality. We critically reviewed 32 studies on Medicaid managed care (2011–2019). Authors reported state-specific cost savings and instances of increased access or quality with implementation or redesign of Medicaid managed-care programs. Studies on high-risk populations (e.g., disabled) found improvements in quality specific to a state or a high-risk population. A unique model of managed care (i.e., the Oregon Health Plan) was associated with reduced costs and improved access and quality, but results varied by comparison state. New trends in the literature focused on analysis of auto-assignment algorithms, provider networks, and plan quality. More analysis of costs jointly with access/quality is needed, as is research on managing long-term care among elderly and disabled Medicaid recipients.

Does Health Status Matter? Examining the Experiences of the Chronically Ill in Medicaid Managed Care

2002 ◽  
Vol 21 (1) ◽  
pp. 53-65 ◽  
Author(s):  
Marlys J. Mason ◽  
Debra L. Scammon ◽  
Robert P. Huefner
Keyword(s):  
Public Policy ◽  
Health Status ◽  
Managed Care ◽  
General Population ◽  
Special Needs ◽  
Continuity Of Care ◽  
Cost Efficiency ◽  
Chronically Ill ◽  
Medicaid Managed Care ◽  
Policy Initiatives

Managed care's promises of improved cost efficiency and continuity of care to the general population are being tested by the higher demands of Medicare and Medicaid populations, including many chronically ill individuals. By examining and comparing satisfaction among chronically ill and healthier enrollees and between Medicaid and non-Medicaid enrollees, the authors develop an understanding of how satisfaction among the chronically ill provides assessments that are important to all enrollees. The authors examine public policy initiatives in the context of the special needs of the chronically ill to determine whether the initiatives are likely to help generate improvements with respect to aspects of care and access that are most important to the chronically ill and ultimately to enrollees in general.

Managed Care Administrators' Opinion of Vocational Reahbilitation Services

1996 ◽  
Vol 27 (1) ◽  
pp. 42-44
Author(s):  
Reginald L. Gibbs ◽  
John M. Dodd ◽  
Anton Hecimovic ◽  
Elia Nickoloff
Keyword(s):  
Health Care ◽  
Managed Care ◽  
Vocational Rehabilitation ◽  
The United States ◽  
Rehabilitation Services ◽  
Short Term ◽  
Managed Care Programs ◽  
Vocational Rehabilitation Services ◽  
Managed Care Organizations

Rising health care insurance premiums have forced many businesses and institutions to examine cost-cutting measures to lower health care costs. Managed care is one measure that has become widespread throughout the United States. The problem was to learn how managed care administrators view the role and purpose of vocational rehabilitation services in their organizations and if these services will lower short-term and long-term use. A survey was sent to the administrators of fifty managed care organizations in the states of Arizona, Colorado, Oregon, and Washington. Twenty of the fifty administrators responded to the survey. Results show that only one of the managed care organizations offered vocational rehabilitation services to their enrollees. The results also show that three responded that short-term use and ten responded that long-term use of managed care programs would be reduced if vocational rehabilitation services were offered.

Coordinating the Care of the Chronically Ill in a World of Managed Care

2000 ◽  
Vol 24 (3) ◽  
pp. 12-20 ◽  
Author(s):  
Marita Schifalacqua ◽  
Mary Hook ◽  
Paula OʼHearn ◽  
Mary Schmidt
Keyword(s):  
Managed Care ◽  
Chronically Ill

scholarly journals Utilization of Services by Chronically Ill People in Managed Care and Indemnity Plans: Implications for Quality

2003 ◽  
Vol 40 (1) ◽  
pp. 57-70 ◽  
Author(s):  
Stephen M. Davidson ◽  
Harriet Davidson ◽  
Heidi Miracle-McMahill ◽  
J. Michael Oakes ◽  
Sybil Crawford ◽  
...  
Keyword(s):  
Primary Care ◽  
Managed Care ◽  
Chronic Conditions ◽  
Primary Care Physicians ◽  
Chronically Ill ◽  
Hospital Emergency Department ◽  
Hospital Emergency ◽  
Utilization Of Services ◽  
Managed Care Organizations

Because incentives for managed care organizations favor cost containment, concerns have been raised that quality of care has suffered, especially for chronically ill people. This study compares utilization rates of managed care and indemnity patients with three chronic conditions, using five years of claims records (1993–97) from private plans and Medicare in one market. Findings show that for all three conditions, managed care patients were more likely to see both primary care physicians and specialists within a year, but less likely to use a hospital emergency department or to be an inpatient. Assuming that patients with these illnesses should see a physician annually and that good primary care reduces the need for emergency and inpatient services, it appears that the patterns of care used by chronically ill managed care patients in this market do not reflect lower quality than that received by similar indemnity patients.

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