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Health Maintenance Organizations

Journal Article
Content and Actionability of Recommendations to Providers After Shadow Coaching
This study aimed to examine the content of the recommendations given to providers aimed at improving provider-patient interactions, characterize these recommendations, and examine their actionability.
Mar 4, 2022
Report
Evaluating New York's Medicaid Section 1115 Waiver
New York State’s Medicaid Section 1115 Waiver seeks to enroll a majority of Medicaid beneficiaries into managed care, increase access and service quality, and expand coverage to more low-income New Yorkers. RAND researchers examined whether two components of the 1115 Demonstration Waiver have helped achieve the program’s goals.
Dec 2, 2021
Journal Article
Care Management Reduced Infant Mortality for Medicaid Managed Care Enrollees in Ohio
The Ohio Department of Medicaid introduced requirements to be delivered by Medicaid managed care organizations (MCOs). This study evaluated the impact of care management on reducing infant mortality in the largest Medicaid MCO in Ohio.
Feb 12, 2021
Journal Article
The Challenge of Determining Appropriate Care in the Era of Patient-Centered Care and Rising Health Care Costs
The goal of health care is to ensure that patients receive the right care for the right patient for the right problem at the right time from the right provider. Inappropriate care is costly. The challenge is to define and increase delivery of appropriate care.
Dec 12, 2019
Journal Article
Medical Practice Consolidation and Physician Shared Patient Network Size, Strength, and Stability
Practice consolidation can increase the stability of physician networks, which may have positive implications for organizational effectiveness.
Aug 20, 2019
Journal Article
Medicare Advantage Associated With More Racial Disparity Than Traditional Medicare For Hospital Readmissions
Risk-reduction strategies adopted by Medicare Advantage plans to prevent hospital readmissions have not succeeded in lowering the markedly higher rates of readmission for black patients compared to white patients.
Jul 26, 2017
Journal Article
Does Medicare Advantage Enrollment Affect Home Healthcare Use?
Medicare Advantage beneficiaries use less home health than do their Fee-for-Service counterparts, but there is marked regional variation in use by both groups.
Jan 25, 2017
Journal Article
Differences in Nursing Home Quality Between Medicare Advantage and Traditional Medicare Patients
Researchers found little difference in the quality of nursing home care provided to Medicare enrollees in managed care and those enrolled in traditional fee-for-service nursing homes.
Oct 18, 2016
Commentary
Introducing Value-Based Purchasing into TRICARE Reform
Congress is considering how to update TRICARE, the U.S. Department of Defense health benefits program. In this Perspective, the authors evaluate two existing proposals that incorporate value-based purchasing and describe a hybrid alternative.
Apr 19, 2016
Dissertation
Once A Cure; Second A Waste: Examining Hospital Readmission Rates of the Commercially Insured Under 65 Population
Uses a dataset that covers inpatient hospital admissions of a population of commercially insured patients under age 65 from California during 2003-2012, this dissertation makes contributions to the knowledge gap in the literature.
Feb 19, 2016
Journal Article
Innovative Care Models for High-Cost Medicare Beneficiaries: Delivery System and Payment Reform to Accelerate Adoption
This paper illustrates how Medicare Advantage plans and accountable care organizations could benefit from adopting innovative care delivery models, and suggests policy changes to accelerate spread.
Jul 7, 2015
Report
Improving Care for Chronic Conditions: Current Practices and Future Trends in Health Plan Programs
Documents the current range of health plans' chronic care management services, identifies best practices and industry trends, and examines factors in the plans' operating environment that limit their ability to optimize chronic care programs.
Jun 3, 2015
Report
Final Report: Evaluation of Tools and Metrics to Support Employer Selection of Health Plans
This report attempts to help employers understand the structural differences between health plans and the performance dimensions along which plans can differ, as well as to educate employers about available tools to evaluate plan options.
Apr 3, 2014
Journal Article
Beyond Black and White: Race/Ethnicity and Health Status Among Older Adults
This study examined physical and mental health, health symptoms, sensory and functional limitations, risk factors, and multimorbidity among older Medicare managed care members to assess disparities associated with race/ethnicity.
Mar 1, 2014
Journal Article
Review of Experiences in Three Countries Informs England's Patient Choice Scheme
The experiences of Finland, Norway, and Sweden in offering patient choice schemes highlight England's need to carefully monitor the impact of enhanced choice in primary care to ensure that related policies truly enhance access to and improve the quality of care, and not inadvertently benefit those who are more able to exercise choice.
Sep 1, 2013
Journal Article
Does the Racial/Ethnic Composition of Medicare Advantage Plans Reflect Their Areas of Operation?
Investigating if the racial/ethnic composition of Medicare Advantage plans reflect the composition of their areas of operation revealed little evidence that health plans are selectively underenrolling blacks, Latinos, or Asians to a substantial degree.
Aug 28, 2013
Journal Article
Care Experiences of Managed Care Medicare Enrollees Near the End of Life
Research based primarily on reports from an individual's surviving relatives often suggests that end-of-life care experiences are particularly poor. However, this examination of reports from patients found that those who died within a year of being surveyed reported slightly better experiences than other enrollees.
Feb 4, 2013
Journal Article
Health-related Quality of Life and Quality of Care in Specialized Medicare-managed Care Plans
This research indicates that beneficiaries in 3 types of special needs plans show evidence of worse health-related quality of life.
Jan 1, 2013
Blog
A Cure for Overtreatment: RAND Guidelines for Appropriate Care
Reducing inappropriate and wasteful tests, treatments and procedures has the potential to save billions annually and simultaneously improve the quality and safety of American medicine, writes Art Kellermann.
Aug 9, 2012
News Release
Expanding Consumer-Directed Health Plans Could Help Cut Overall Health Care Spending
If consumer-directed health plans grow to account for half of all employer-sponsored insurance in the United States, health costs could drop by $57 billion annually—about 4 percent of all health care spending among the nonelderly.
May 7, 2012

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RAND Topic:
Managed Health Care

Research conducted by

RAND Health Care

Researcher Spotlight

Erin Audrey Taylor

Senior Policy Researcher

Erin Taylor (she/her) is a senior policy researcher at the RAND Corporation. Her research addresses a broad range of health care insurance, prescription drug, and care quality issues, including the impact of insurance benefit design on use of opioids and specialty drugs. Taylor is currently…
M. Susan Ridgely

Adjunct Senior Health Policy Researcher

M. Susan Ridgely is an adjunct senior health policy researcher at the RAND Corporation and a Pardee RAND Graduate School affiliate faculty member. She has more than 30 years of experience in health services research and policy analysis.

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