We use Data Envelopment Analysis (DEA) to measure the relative technical efficiencies of 164 HMOs licensed to practice in the United States in 1995 with data collected from the American Association of Health Plans. He...
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The rancor accompanying the repeal of mosl of the 1988 Medicare Catastrophic Act reflects both the national need to improve health and long-term care benefits for the elderly and the political obstacles to finding new...
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The Harvard Community Health Plan commissioned a cross-functional project team to improve the accuracy of the members' data base because inaccurate patient phone numbers and addresses were a major obstacle for cli...
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The Harvard Community Health Plan commissioned a cross-functional project team to improve the accuracy of the members' data base because inaccurate patient phone numbers and addresses were a major obstacle for clinicians seeking to provide high-quality service to patients. Accurate demographic information is essential to enable clinicians to contact patients quickly regarding lab results or follow-up care. The team members applied a quality improvement problem-solving methodology that required them to focus on the few vital problems and to test problems using data analysis. As a result, the team saw firsthand that staff members were not to blame for the inaccurate demographic information;the problem was in the automated system that obtains, updates, and maintains the records.
Motives for health plan (HP)-academic health center (AHC) relationships, including both deterrents and inducements, are explored through a review of 153 articles, published from 1970 through 1997, in academic and heal...
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Motives for health plan (HP)-academic health center (AHC) relationships, including both deterrents and inducements, are explored through a review of 153 articles, published from 1970 through 1997, in academic and health care industry journals about HP-AHC relationships. Every article that met inclusion criteria was coded for year, journal, author, audience, type of article, organization of focus, purposes, priorities, affiliation motives, and issues. Peak years were 1973 (the passage of HMO legislation) and the most recent years from 1994 through 1997. The motives to affiliate were found to be different for AHCs and HPs (e.g physician attitudes, a deterrent for AHCs and inducement for HPs;resources, a deterrent for HPs and inducement for AHCs). Increases in size of HPs and decreases in political power of AHCs have resulted in changes to motives to form relationships. Motives must be acknowledged to move from competitive to collaborative relationships.
The mental health organizations in the mental health phase-in were Oregon's pioneers moving into public managed care. A delicate balance between county mental health authority and private expertise was struck loca...
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The mental health organizations in the mental health phase-in were Oregon's pioneers moving into public managed care. A delicate balance between county mental health authority and private expertise was struck locally to yield a variety of organizational models across the state.
Arizona has developed a Medicaid program under the waiver provisions of Title XIX of the Social Security Act. This paper examines how well a managed care system for Medicaid recipients works in delivering prevention s...
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Arizona has developed a Medicaid program under the waiver provisions of Title XIX of the Social Security Act. This paper examines how well a managed care system for Medicaid recipients works in delivering prevention services. The conflicts between the welfare system and the delivery of prevention services are explored.
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