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- in Grantee Publication by Conrad, D.A., Maynard, C., Cheadle, A., Ramsey, S., et al.
Growth of at-risk managed care contracts between health plans and medical groups has been well documented, but less is known about the nature of financial incentives within those medical groups or their effects on health care utilization.
- in Grantee Publication by Garnick, D.W., Swartz, K., Skwara, K.C.
In this paper we use the reforms to the individual health insurance market in New Jersey to illustrate the intricate interaction between insurance agents and insurance reform initiatives.
- in Grantee Publication by Kilbreth, E.H., Coburn, A.F., McGuire, C., Martin, D.P., Diehr, P., Madden, C.W., and Skillman, S.M.
Risk contracting by states for coverage of previously uninsured populations has been hampered by uncertainty regarding likely claims experience. This study reports on the utilization experience of two state programs offering subsidized coverage in commercial managed care organizations to low-income and previously uninsured people.
- in Grantee Publication by Halm, E.A., Causino, N., and Blumenthal, D.
Nearly all managed care plans rely on a physician "gatekeeper" to control use of specialty, hospital, and other expensive services. Gatekeeping is intended to reduce costs while maintaining or improving quality of care by increasing coordination and prevention and reducing duplicative or inappropriate care. Whether gatekeeping achieves these goals remains largely unproven.
- HMO Mergers: Estimating Impacts on Premiums and Costs November 1997in Grantee Publication by Christianson, J., Feldman, R., and D. Wholey
- HMO Market Structure and Performance: 1985-1995 November 1997in Grantee Publication by Wholey, D., Christianson, J., Engberg, J., and C. Bryce
- in Grantee Publication by Rice, T., Graham, M.L., and P.D. Fox
- in Grantee Publication by Stearns, S.C., Slifkin, R.T., Thorpe, K., and T.A. Mroz
- Quality Assessment in Contracting for Tertiary Care Services by HMOs: A Case Study of Three Markets February 1997in Grantee Publication by Schulman, K.A., Rubenstein, L.E., Seils, D.M, Harris, M., Hadley, J., and Escarce, J.J.
Few studies have examined the provision of tertiary care services by managed care organizations (MCOs). Moreover, little is known about the role of quality assessment and quality assurance mechanisms in the contracting process. Site visits were conducted in 1995 in three geographic areas to describe and evaluate the contracting processes for tertiary care services, especially neonatal intensive care and coronary artery bypass graft surgery, of health maintenance organizations (HMOs). Three market areas in the United States, each with differing levels of maturity, as primarily defined in terms of managed care penetration, were selected for study.