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Capitated Contracting of Integrated Health Provider Organizations [1]

Inquiry
Vol. 36, No. 4
December 1999
Bazzoli, G.J., Dynan, L., and L.R. Burns
pp. 426-44

This paper examines global capitation of integrated health provider organizations that link physicians and hospitals, such as physician-hospital organizations and management service organizations. These organizations have proliferated in recent years, but their contracting activity has not been studied. We develop a conceptual model to understand the capitated contracting bargaining process.

Grants: 
Physician-Organization Arrangements: Impact on Integration and Managed Care [2]
Topic: 
Managed Care [3]
Topic: 
Organization and Supply of Care [4]
Topic: 
Provider Payment and Behavior [5]

Health Care Rationing: What it Means [6]

Brookings Policy Brief Summary-December 2005
Policy Brief #147
December 2005
Aaron, H.J.

The United States spends more on health care than any other nation. In 2003, medical spending made up more than 15 percent of U.S. GDP, and if historical trends persist, this share will climb to more than one-third of GDP by 2040. With medical technology advancing at an ever-increasing rate, the potential for spending on procedures not worth their costs is growing. But there are few good ideas for reining in medical costs without hurting patients.

Grants: 
The Painful Prescription: Revisited [7]
Topic: 
Costs and Cost Containment [8]

Employer Health Insurance Offerings and Employee Enrollment Decisions [9]

Health Services Research - October 2005
Vol. 40, No. 5, Pt. 1
October 2005
Polsky, D., Stein, R., Nicholson, S., and M.K. Bundorf
pp. 1259-78

Objective. To determine how the characteristics of the health benefits offered by employers affect worker insurance coverage decisions.

Data Sources. The 1996–1997 and the 1998–1999 rounds of the nationally representative Community Tracking Study Household Survey.

Grants: 
Health Plan Choices and Adverse Selection in Employer Sponsored InsuranceHealth Plan Choices and Adverse Selection in Employer-Sponsored Health Insurance [10]
Topic: 
Benefit Design [11]
Topic: 
Consumer Behavior [12]
Topic: 
Insurance Coverage [13]

Health Care Reform Through Medicaid Managed Care: Tennessee (TennCare) as a Case Study and a Paradigm [14]

Vanderbilt Law Review
Vol. 53
January 2000
Blumstein, J. and F.A. Sloan

Tennessee's Medicaid managed care program TennCare, is widely regarded as one of the nation's most innovative and comprehensive attempts to reform Medicaid and expand coverage to the uninsured through Medicaid managed care. This paper begins with an analysis of historical developments within the Medicaid program in the early 1990s that forced Tennessee to dramatically change its Medicaid program to cope with rising costs and threatened revenues.

Grants: 
Evaluation of the TennCare Health Reform Plan [15]
Topic: 
Access [16]
Topic: 
Legal and Regulatory Environment [17]
Topic: 
Managed Care [3]
Topic: 
Medicaid and SCHIP [18]
Topic: 
Quality of Care [19]

What Can We Say About the Impact of Public Reporting? Inconsistent Execution Yields Variable Results [20]

Annals of Internal Medicine-January 15, 2008
Vol. 148, No. 2
January 15, 2008
Hibbard, J.H.
pp. 160-1

View full article [21]...

 

Grants: 
Assessing the Impact of a Public Report on Hospital Quality: A Controlled Experiment in the State of Wisconsin [22]
Topic: 
Consumer Behavior [12]
Topic: 
Organization and Supply of Care [4]
Topic: 
Provider Payment and Behavior [5]
Topic: 
Quality of Care [19]

End-of-Life Medicare and Medicaid Expenditures for Dually Eligible Beneficiaries [23]

Health Care Financing Review - Summer 2006
Vol. 27, No. 4
Summer 2006
Liu, K., Wiener, J.M., and M.R. Niefield
pp. 95-110

In 1995, combined Medicare and Medicaid spending in the last year of life for dually eligible beneficiaries was more than $40,000 per beneficiary. Medicaid’s share, primarily for long-term care (LTC), constituted about 40 percent of the total. Beneficiaries under age 65, Black persons, and individuals who died in a hospital had higher than average expenditures. The vast majority (86 percent) received some form of supportive services (nursing home, home care, hospice services).

Grants: 
Factors Affecting End-of-Life Care for Beneficiaries Who Are Dually Eligible for Medicare and Medicaid [24]
Topic: 
Costs and Cost Containment [8]
Topic: 
End-of-Life Care [25]
Topic: 
Long-Term Care [26]
Topic: 
Medicaid and SCHIP [18]
Topic: 
Medicare [27]

How Does the Employer Contribution for the Federal Employees Health Benefits Program Influence Plan Selection? [28]

Health Affairs--March/April 2003
Vol. 22, No. 2
March/April 2003
Florence, C.S. and K.E. Thorpe
pp. 211-8

Market reform of health insurance is proposed to increase coverage and reduce growth in spending by providing an incentive to choose low-cost plans. However, having a choice of plans could result in risk segmentation. Risk-adjusted payments have been proposed to address risk segmentation but are criticized as ineffective. An alternative to risk adjustment is to subsidize premiums, as in the Federal Employees Health Benefits Program (FEHBP). Subsidizing premiums may also increase total premium spending.

Grants: 
Health Plan Selection for Medicare Eligible Enrollees in the Federal Employees Health Benefits Program [29]
Topic: 
Benefit Design [11]
Topic: 
Consumer Behavior [12]
Topic: 
Insurance Coverage [13]
Topic: 
Risk Adjustment [30]

Do Increases in Payments For Obstetrical Deliveries Affect Prenatal Care? [31]

Public Health Report
Vol. 100, No. 3
May 1995
Fox, M. and K. Phua
pp. 319-26

Raising fees is one of the primary means that State Medicaid Programs employ to maintain provider participation. While a number of studies have sought to quantify the extent to which this policy retains or attracts providers, few have looked at the impact of these incentives on patients. In this study, the authors used Medicaid claims data to examine changes in volume and site of prenatal care among women who delivered babies after the Maryland Medicaid Program raised physicians fees for deliveries 200 percent at the end of its 1986 fiscal year.

Grants: 
Enhancing Access to Obstetrical Care: An Evaluation of A Change in Medicaid Payment Policy [32]
Topic: 
Access [16]
Topic: 
Legal and Regulatory Environment [17]
Topic: 
Medicaid and SCHIP [18]
Topic: 
Provider Payment and Behavior [5]

The Effect of HMOs on the Inpatient Utilization of Medicare Beneficiaries [33]

Health Services Research-October 2004
Vol. 39, No. 5
October 2004
Dhanani, N., O'Leary, J.F., Keeler, E., Bamezai, A., and G. Melnick
pp. 1607–28

Objective: To determine the effect of joining HMOs (health maintenance organizations) on the inpatient utilization of Medicare beneficiaries.

Data Sources: We linked enrollment data on Medicare beneficiaries to patient discharge data from the California Office of Statewide Health Planning and Development (OSHPD) for 1991-1995. 

Grants: 
Medicare Risk-Contracting: Impact on Access and Quality for Medicare HMO Enrollees and Vulnerable Populations [34]
Topic: 
Insurance Coverage [13]
Topic: 
Managed Care [3]
Topic: 
Medicare [27]

Managed Care Patient Protection or Provider Protection? A Qualitative Assessment [35]

American Journal of Medicine--December 2004
Vol. 117, No. 12
December 2004
Hall, M.A.
pp. 932-7

Purpose
Opponents of managed care regulation allege that a patient’s bill of rights, in reality, represents provider protections motivated by the desire to curtail the economic onslaught of managed care. This claim is assessed through a large qualitative study of state managed care patient protection laws.

Grants: 
Evaluating Managed Care Patient Protection Laws [36]
Topic: 
Legal and Regulatory Environment [17]
Topic: 
Managed Care [3]
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Links:
[1] http://www.hcfo.org/publications/capitated-contracting-integrated-health-provider-organizations
[2] http://www.hcfo.org/grants/physician-organization-arrangements-impact-integration-and-managed-care
[3] http://www.hcfo.org/topics/managed-care
[4] http://www.hcfo.org/topics/organization-and-supply-care
[5] http://www.hcfo.org/topics/provider-payment-and-behavior
[6] http://www.hcfo.org/publications/health-care-rationing-what-it-means
[7] http://www.hcfo.org/grants/painful-prescription-revisited
[8] http://www.hcfo.org/topics/costs-and-cost-containment
[9] http://www.hcfo.org/publications/employer-health-insurance-offerings-and-employer-enrollment-decisions
[10] http://www.hcfo.org/grants/health-plan-choices-and-adverse-selection-employer-sponsored-insurance-health-plan-choices-an
[11] http://www.hcfo.org/topics/benefit-design
[12] http://www.hcfo.org/topics/consumer-behavior
[13] http://www.hcfo.org/topics/insurance-coverage
[14] http://www.hcfo.org/publications/health-care-reform-through-medicaid-managed-care-tennessee-tenncare-case-study-and-para
[15] http://www.hcfo.org/grants/evaluation-tenncare-health-reform-plan
[16] http://www.hcfo.org/topics/access
[17] http://www.hcfo.org/topics/legal-and-regulatory-environment
[18] http://www.hcfo.org/topics/medicaid-and-schip
[19] http://www.hcfo.org/topics/quality-care
[20] http://www.hcfo.org/publications/what-can-we-say-about-impact-public-reporting-inconsistent-execution-yields-variable-re
[21] http://www.annals.org/content/148/2/160.full.pdf+html
[22] http://www.hcfo.org/grants/assessing-impact-public-report-hospital-quality-controlled-experiment-state-wisconsin
[23] http://www.hcfo.org/publications/end-life-medicare-and-medicaid-expenditures-dually-eligible-beneficiaries
[24] http://www.hcfo.org/grants/factors-affecting-end-life-care-beneficiaries-who-are-dually-eligible-medicare-and-medicaid
[25] http://www.hcfo.org/topics/end-life-care
[26] http://www.hcfo.org/topics/long-term-care
[27] http://www.hcfo.org/topics/medicare
[28] http://www.hcfo.org/publications/how-does-employer-contribution-federal-employees-health-benefits-program-influence-plan
[29] http://www.hcfo.org/grants/health-plan-selection-medicare-eligible-enrollees-federal-employees-health-benefits-program
[30] http://www.hcfo.org/topics/risk-adjustment
[31] http://www.hcfo.org/publications/do-increases-payments-obstetrical-deliveries-affect-prenatal-care
[32] http://www.hcfo.org/grants/enhancing-access-obstetrical-care-evaluation-change-medicaid-payment-policy
[33] http://www.hcfo.org/publications/effect-hmos-inpatient-utilization-medicare-beneficiaries
[34] http://www.hcfo.org/grants/medicare-risk-contracting-impact-access-and-quality-medicare-hmo-enrollees-and-vulnerable-pop
[35] http://www.hcfo.org/publications/managed-care-patient-protection-or-provider-protection-qualitative-assessment
[36] http://www.hcfo.org/grants/evaluating-managed-care-patient-protection-laws
[37] http://www.hcfo.org/taxonomy/term/4
[38] http://www.hcfo.org/taxonomy/term/4?page=45
[39] http://www.hcfo.org/taxonomy/term/4?page=40
[40] http://www.hcfo.org/taxonomy/term/4?page=41
[41] http://www.hcfo.org/taxonomy/term/4?page=42
[42] http://www.hcfo.org/taxonomy/term/4?page=43
[43] http://www.hcfo.org/taxonomy/term/4?page=44
[44] http://www.hcfo.org/taxonomy/term/4?page=47
[45] http://www.hcfo.org/taxonomy/term/4?page=48