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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.