PUP 4931r Lecture Notes - Lecture 81: Managed Care, Medicare Advantage, Health Maintenance Organization
16 May 2018
School
Department
Course
Professor
Does Managed Care Lead To Better Or Worse Quality Of Care? Robert Miller and
Harold LuftHealth Affairs Sept-Oct 1997
Reviewed results from 37 studies
Equal number of significantly better and worse outcomes in HMO and Non HMO
populations.
But, Medicare HMO patients with chronic conditions showed worse quality of
care.
No difference in physician or hospital resource use
Enrollee satisfaction varied by measure and enrollee type
Fears that HMO enrollment leads to worse quality care were not supported
Hopes that HMO enrollment would improve quality also not supported.
Risk adjustment, quality measurement & reporting, clinical practice change, all
need improvement.
Inappropriate Utilization in Fee-for-Service Medicare and Medicare Advantage
PlansShriram Parashuram, Seung Kim, and Bryan DowdAmerican Journal of
Medical Quality 2018, Vol. 33(1) 58–64
Controlling for covariates, potentially inappropriate ED visits and ACS admissions
remained at their low baseline values for FFS Beneficiaries who switched from FFS
Medicare to MA plans,
but rose for MA enrollees switching to FFS Medicare.
PATIENT OUTCOMES AND MANAGED CARE: WHAT WAS THE IMPACT OF
THESTATE REGULATORY BACKLASH? TINA C. HIGHFILL, Virginia Commonwealth
University 2017
Hundreds of state regulations were passed duig the aaged ae aklash
of the late 1990s and early 2000s.
Many of these anti-managed care regulations eased or eliminated constraints on
patient utilization of health care services imposed by managed care organizations.
Other regulations gave managed care providers more flexibility in the way they
practiced care or helped patients appeal denials of claims.
The results indicate the regulations did improve patient-reported outcomes, but
to varying degrees and only in the latter period of the backlash.
Specifically, managed care enrollees who lived in states that adopted moderate-
intensity regulations between 2000 and 2004 reported relatively better
improvements in access to care and confidence in their provider than did
managed care enrollees in states with high or low-intensity backlash regulations.
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Document Summary
Equal number of significantly better and worse outcomes in hmo and non hmo populations. But, medicare hmo patients with chronic conditions showed worse quality of care. No difference in physician or hospital resource use. Enrollee satisfaction varied by measure and enrollee type. Fears that hmo enrollment leads to worse quality care were not supported. Hopes that hmo enrollment would improve quality also not supported. Risk adjustment, quality measurement & reporting, clinical practice change, all need improvement. Inappropriate utilization in fee-for-service medicare and medicare advantage. Plansshriram parashuram, seung kim, and bryan dowdamerican journal of. Controlling for covariates, potentially inappropriate ed visits and acs admissions remained at their low baseline values for ffs beneficiaries who switched from ffs. Medicare to ma plans, but rose for ma enrollees switching to ffs medicare. Patient outcomes and managed care: what was the impact of. Hundreds of state regulations were passed du(cid:396)i(cid:374)g the (cid:862)(cid:373)a(cid:374)aged (cid:272)a(cid:396)e (cid:271)a(cid:272)klash(cid:863) of the late 1990s and early 2000s.
