摘要:

Most provider organizations rely on health plan or market-based information about capitation rates, per member per month costs, and utilization trends to benchmark their performance. However, these statistics can be misleading because of differences in enrollee mix and contracting terms across provider organizations. This article describes the limitations of health plan contract provisions in protecting against adverse selection. It describes various actuarial and statistical data sources for evaluation of adverse selection. The article then presents various approaches to risk adjustment on a population basis and their use in quantifying adverse selection for health plan contract negotiations.

ISSN:0148-9917    

出版商:OVID    

年代:1998

数据来源: OVID

摘要:

The ability to link pharmacy claims and clinical laboratory result databases in a managed care setting holds great promise as an outcomes management tool. The authors have created a powerful disease management capability that generates dynamic, disease-specific reports containing actionable, provider-patient-level laboratory and pharmacy information. This system is used to send reports to primary care physicians in an independent practice association (IPA)-model managed care setting to improve the care of patients with diabetes mellitus. This systematic feedback methodology can augment physician decision-making behavior, promote compliance with national guidelines, and measure Improvement in plan-level, population-based outcomes over time.

ISSN:0148-9917    

出版商:OVID    

年代:1998

数据来源: OVID

摘要:

This article assesses the validity of ambulatory administrative and encounter data and patient self-reported information compared with information contained in the ambulatory medical record for 17 chronic diseases. Using a sample of 213 adults (18 to 64 years old) and seniors (65 years and older) enrolled in a health maintenance organization and receiving care at a multispecialty group practice in Minneapolis, Minnesota, sensitivity and specificity for claims and self-report were calculated for each chronic condition using the medical record as the criterion standard. The analysis was performed first by blinded review and then repeated with an unblinded review.

ISSN:0148-9917    

出版商:OVID    

年代:1998

数据来源: OVID

摘要:

Two studies were conducted that assessed health perceptions and functional health status among an urban, low-income population in the southeastern region of the United States. The first study was conducted with 176 hospitalized indigent patients prior to discharge from a county hospital. Patients were administered the Short Form-36 (SF-36) health status questionnaire and two additional questions regarding perceptions of health. The second study was conducted in the same geographic region with a nonhospitalized, low-income population. The SF-36 was administered by telephone to 546 randomly selected interview respondents. The results demonstrated consistent differences between black and white respondents in referents for self-perceived health. It is suggested that health expectations and perceptions may be indicative of the cultural, contextual, and social-political factors that affect the lives of this urban, low income population. The validity of global single-item health indicators for use among low-income populations is questioned. Further research is needed to develop patient-based measures that accurately reflect the meanings and values of low-income patient groups.

ISSN:0148-9917    

出版商:OVID    

年代:1998

数据来源: OVID

ISSN:0148-9917    

出版商:OVID    

年代:1998

数据来源: OVID

ISSN:0148-9917    

出版商:OVID    

年代:1998

数据来源: OVID

摘要:

The purpose of this study was to examine how media sources influence an individual's reported choice of a physician as compared to personal referral sources and how consumers use the Yellow Pages to search for health care information. A random sample of 762 residents was systematically selected from the Charlotte, North Carolina White Pages and was asked to participate in a 20-item descriptive phone survey designed and tested by the investigator. Five hundred and seventy-eight individuals completed the survey, with a response rate of 75.9%. This study supports previous research suggesting that personal referrals are the most influential sources in selecting health care services. Therefore, satisfying and delighting the physician's/practice's existing client base may be one of the most potent advertising resources at hand. Mass media sources played a relatively minor role in influencing provider selection in this study. Nevertheless, it should not be dismissed inasmuch as the media may be an important way for physicians to promote “brand recognition,” a problem not considered in this study. Finally, approximately 28% of the participants were “Yellow Pages users”; that is, individuals who tended to be heavy users of the Yellow Pages and used it for multiple information-seeking tasks. The findings related to the Yellow Pages suggest that while it may be useful to advertise in the Yellow Pages, a more modest financial allocation to this source may be considered.

ISSN:0148-9917    

出版商:OVID    

年代:1998

数据来源: OVID

摘要:

The integration of clinical guidelines with office systems has great potential to improve population health. This article shows how simple office systems can be developed and applied to expand the impact of clinical guidelines on the health of populations of patients enrolled in managed care organizations, using diabetes as an example. The basic tools needed to improve population health include (1) clinical guidelines that clearly articulate important and specific health goats; (2) a clinical database that can identity patients who are eligible for guideline-recommended care, monitor this group of patients, and classify patients who need different levels of intervention; and (3) clinics that are organized in a way that facilitates provision of guideline-directed clinical care based on cues from the clinical database. This article illustrates a successful application of this strategy to improve the care of a population of patients with diabetes enrolled in health maintenance organization-owned clinics.

ISSN:0148-9917    

出版商:OVID    

年代:1998

数据来源: OVID

ISSN:0148-9917    

出版商:OVID    

年代:1998

数据来源: OVID

ISSN:0148-9917    

出版商:OVID    

年代:1998

数据来源: OVID