The Experts below are selected from a list of 10551 Experts worldwide ranked by ideXlab platform
Shelah Leader - One of the best experts on this subject based on the ideXlab platform.
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pwm1 premature birth and resource utilization in a large employment based Independent Practice Association ipa
Value in Health, 2001Co-Authors: Cr Harley, Shelah LeaderAbstract:OBJECTIVES: While premature birth is one of the costliest hospital events, the total direct medical cost of care associated with the birth of a premature infant has not been documented from a societal perspective. METHODS: Retrospective analysis of administrative claims data from a large, employment based IPA covering a total of 3 million members in 1998 was conducted. All infants born in calendar year 1998 with a birth diagnosis of prematurity (<38 weeks gestation) and low birth weight (<2500 grams) [ICD 9-CM codes 765.0x and 765.1x] were identified. Eligible infants were required to be continuously enrolled in the plan during the birth hospitalization, have complete claims histories, and have prescription drug benefits. A secondary analysis of resource utilization during the first 30 days post-initial hospital discharge was conducted among surviving infants who were continuously enrolled during that 30 day period. Costs reflect payments by the plan, patient deductibles, and co-payments for all covered medical services. RESULTS: In 1998, 1,208 births to enrollees were premature and eligible for study; 28% were multiple births. Twenty-one infants (1.7%) died during the birth hospitalization. The total direct medical cost of the birth hospitalization was $35.5 million. During the first 30 days post discharge, 133 (12.4%) of the remaining eligible infants (n = 1,076) had claims for inpatient services. Total direct cost of all covered medical services during this period was an additional $1.2 million. CONCLUSION: Even in a relatively low risk population, the direct medical costs associated with premature birth were very high (nearly $37 million for about 1,000 infants) and need for acute medical care continued in the first month post-discharge. Appropriate medical management of this high risk population may be cost-effective.
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PWM1: PREMATURE BIRTH AND RESOURCE UTILIZATION IN A LARGE EMPLOYMENT BASED Independent Practice Association (IPA)
Value in Health, 2001Co-Authors: Cr Harley, Shelah LeaderAbstract:OBJECTIVES: While premature birth is one of the costliest hospital events, the total direct medical cost of care associated with the birth of a premature infant has not been documented from a societal perspective. METHODS: Retrospective analysis of administrative claims data from a large, employment based IPA covering a total of 3 million members in 1998 was conducted. All infants born in calendar year 1998 with a birth diagnosis of prematurity (
Hattie Skubik Hanley - One of the best experts on this subject based on the ideXlab platform.
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Differences in the kinds of problems consumers report in staff/group health maintenance organizations, Independent Practice Association/network health maintenance organizations, and preferred provider organizations in California.
Medical Care, 2001Co-Authors: Helen Halpin Schauffler, Sara B. Mcmenamin, Juliette Cubanski, Hattie Skubik HanleyAbstract:Background. Little is known about the extent to which consumers have specific problems with their managed care organizations (MCOs) or whether these problems differ by type of MCO. Objective. To estimate the prevalence at which consumers in managed care report specific problems and to assess whether rates in preferred provider organizations (PPOs), Independent Practice Association (IPA)/network health maintenance organizations (HMOs), and staff/group HMOs differ. Design. Random probability sample of insured adults weighted to reflect the underlying population in California. A computer-assisted telephone interview survey was conducted in September 1997. Logistic regression models estimate the adjusted odds of reporting each problem in the last year in IPA/network HMOs versus PPOs, IPA/network HMOs versus staff/group HMOs, and staff/group HMOs versus PPOs. Subjects. One thousand two hundred one insured adults who had resided in California for ≥12 months. Measures. Prevalence of 11 consumer problems in MCOs. Results. Forty-two percent of adult Californians in managed care in our sample reported ≥1 problem with their MCO in the last year. Adjusted odds that adults in IPA/network or staff/group HMOs reported delays in getting needed care, not receiving the most appropriate or needed care, and being forced to change doctors were higher than for adults in PPOs. Adjusted odds that adults in IPA/network HMOs reported difficulty getting a referral to a specialist and difficulty selecting a doctor or hospital were higher than for adults in PPOs and staff/group HMOs. Adjusted odds that adults in staff/group HMOs reported misunderstandings over benefits and coverage; important benefits not covered; and problems with claims, billing, or payments were lower than for adults in PPOs and IPA/network HMOs. Adjusted odds that consumers in HMOs in our sample reported any problem with their health plan was higher for those in IPA/network HMOs compared with staff/group HMOs. No differences were seen by MCO type in the rates at which consumers reported being denied care or treatment, forced to change medications, or language and communication barriers. Conclusions. Rates at which consumers report problems with managed care and the kinds of problems they report differ significantly across different types of MCOs. These findings have important implications for federal and state policy for consumer protections in managed care.
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differences in the kinds of problems consumers report in staff group health maintenance organizations Independent Practice Association network health maintenance organizations and preferred provider organizations in california
Medical Care, 2001Co-Authors: Helen Halpin Schauffler, Sara B. Mcmenamin, Juliette Cubanski, Hattie Skubik HanleyAbstract:Background. Little is known about the extent to which consumers have specific problems with their managed care organizations (MCOs) or whether these problems differ by type of MCO. Objective. To estimate the prevalence at which consumers in managed care report specific problems and to assess whether rates in preferred provider organizations (PPOs), Independent Practice Association (IPA)/network health maintenance organizations (HMOs), and staff/group HMOs differ. Design. Random probability sample of insured adults weighted to reflect the underlying population in California. A computer-assisted telephone interview survey was conducted in September 1997. Logistic regression models estimate the adjusted odds of reporting each problem in the last year in IPA/network HMOs versus PPOs, IPA/network HMOs versus staff/group HMOs, and staff/group HMOs versus PPOs. Subjects. One thousand two hundred one insured adults who had resided in California for ≥12 months. Measures. Prevalence of 11 consumer problems in MCOs. Results. Forty-two percent of adult Californians in managed care in our sample reported ≥1 problem with their MCO in the last year. Adjusted odds that adults in IPA/network or staff/group HMOs reported delays in getting needed care, not receiving the most appropriate or needed care, and being forced to change doctors were higher than for adults in PPOs. Adjusted odds that adults in IPA/network HMOs reported difficulty getting a referral to a specialist and difficulty selecting a doctor or hospital were higher than for adults in PPOs and staff/group HMOs. Adjusted odds that adults in staff/group HMOs reported misunderstandings over benefits and coverage; important benefits not covered; and problems with claims, billing, or payments were lower than for adults in PPOs and IPA/network HMOs. Adjusted odds that consumers in HMOs in our sample reported any problem with their health plan was higher for those in IPA/network HMOs compared with staff/group HMOs. No differences were seen by MCO type in the rates at which consumers reported being denied care or treatment, forced to change medications, or language and communication barriers. Conclusions. Rates at which consumers report problems with managed care and the kinds of problems they report differ significantly across different types of MCOs. These findings have important implications for federal and state policy for consumer protections in managed care.
Cr Harley - One of the best experts on this subject based on the ideXlab platform.
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pwm1 premature birth and resource utilization in a large employment based Independent Practice Association ipa
Value in Health, 2001Co-Authors: Cr Harley, Shelah LeaderAbstract:OBJECTIVES: While premature birth is one of the costliest hospital events, the total direct medical cost of care associated with the birth of a premature infant has not been documented from a societal perspective. METHODS: Retrospective analysis of administrative claims data from a large, employment based IPA covering a total of 3 million members in 1998 was conducted. All infants born in calendar year 1998 with a birth diagnosis of prematurity (<38 weeks gestation) and low birth weight (<2500 grams) [ICD 9-CM codes 765.0x and 765.1x] were identified. Eligible infants were required to be continuously enrolled in the plan during the birth hospitalization, have complete claims histories, and have prescription drug benefits. A secondary analysis of resource utilization during the first 30 days post-initial hospital discharge was conducted among surviving infants who were continuously enrolled during that 30 day period. Costs reflect payments by the plan, patient deductibles, and co-payments for all covered medical services. RESULTS: In 1998, 1,208 births to enrollees were premature and eligible for study; 28% were multiple births. Twenty-one infants (1.7%) died during the birth hospitalization. The total direct medical cost of the birth hospitalization was $35.5 million. During the first 30 days post discharge, 133 (12.4%) of the remaining eligible infants (n = 1,076) had claims for inpatient services. Total direct cost of all covered medical services during this period was an additional $1.2 million. CONCLUSION: Even in a relatively low risk population, the direct medical costs associated with premature birth were very high (nearly $37 million for about 1,000 infants) and need for acute medical care continued in the first month post-discharge. Appropriate medical management of this high risk population may be cost-effective.
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PWM1: PREMATURE BIRTH AND RESOURCE UTILIZATION IN A LARGE EMPLOYMENT BASED Independent Practice Association (IPA)
Value in Health, 2001Co-Authors: Cr Harley, Shelah LeaderAbstract:OBJECTIVES: While premature birth is one of the costliest hospital events, the total direct medical cost of care associated with the birth of a premature infant has not been documented from a societal perspective. METHODS: Retrospective analysis of administrative claims data from a large, employment based IPA covering a total of 3 million members in 1998 was conducted. All infants born in calendar year 1998 with a birth diagnosis of prematurity (
Helen Halpin Schauffler - One of the best experts on this subject based on the ideXlab platform.
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Differences in the kinds of problems consumers report in staff/group health maintenance organizations, Independent Practice Association/network health maintenance organizations, and preferred provider organizations in California.
Medical Care, 2001Co-Authors: Helen Halpin Schauffler, Sara B. Mcmenamin, Juliette Cubanski, Hattie Skubik HanleyAbstract:Background. Little is known about the extent to which consumers have specific problems with their managed care organizations (MCOs) or whether these problems differ by type of MCO. Objective. To estimate the prevalence at which consumers in managed care report specific problems and to assess whether rates in preferred provider organizations (PPOs), Independent Practice Association (IPA)/network health maintenance organizations (HMOs), and staff/group HMOs differ. Design. Random probability sample of insured adults weighted to reflect the underlying population in California. A computer-assisted telephone interview survey was conducted in September 1997. Logistic regression models estimate the adjusted odds of reporting each problem in the last year in IPA/network HMOs versus PPOs, IPA/network HMOs versus staff/group HMOs, and staff/group HMOs versus PPOs. Subjects. One thousand two hundred one insured adults who had resided in California for ≥12 months. Measures. Prevalence of 11 consumer problems in MCOs. Results. Forty-two percent of adult Californians in managed care in our sample reported ≥1 problem with their MCO in the last year. Adjusted odds that adults in IPA/network or staff/group HMOs reported delays in getting needed care, not receiving the most appropriate or needed care, and being forced to change doctors were higher than for adults in PPOs. Adjusted odds that adults in IPA/network HMOs reported difficulty getting a referral to a specialist and difficulty selecting a doctor or hospital were higher than for adults in PPOs and staff/group HMOs. Adjusted odds that adults in staff/group HMOs reported misunderstandings over benefits and coverage; important benefits not covered; and problems with claims, billing, or payments were lower than for adults in PPOs and IPA/network HMOs. Adjusted odds that consumers in HMOs in our sample reported any problem with their health plan was higher for those in IPA/network HMOs compared with staff/group HMOs. No differences were seen by MCO type in the rates at which consumers reported being denied care or treatment, forced to change medications, or language and communication barriers. Conclusions. Rates at which consumers report problems with managed care and the kinds of problems they report differ significantly across different types of MCOs. These findings have important implications for federal and state policy for consumer protections in managed care.
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differences in the kinds of problems consumers report in staff group health maintenance organizations Independent Practice Association network health maintenance organizations and preferred provider organizations in california
Medical Care, 2001Co-Authors: Helen Halpin Schauffler, Sara B. Mcmenamin, Juliette Cubanski, Hattie Skubik HanleyAbstract:Background. Little is known about the extent to which consumers have specific problems with their managed care organizations (MCOs) or whether these problems differ by type of MCO. Objective. To estimate the prevalence at which consumers in managed care report specific problems and to assess whether rates in preferred provider organizations (PPOs), Independent Practice Association (IPA)/network health maintenance organizations (HMOs), and staff/group HMOs differ. Design. Random probability sample of insured adults weighted to reflect the underlying population in California. A computer-assisted telephone interview survey was conducted in September 1997. Logistic regression models estimate the adjusted odds of reporting each problem in the last year in IPA/network HMOs versus PPOs, IPA/network HMOs versus staff/group HMOs, and staff/group HMOs versus PPOs. Subjects. One thousand two hundred one insured adults who had resided in California for ≥12 months. Measures. Prevalence of 11 consumer problems in MCOs. Results. Forty-two percent of adult Californians in managed care in our sample reported ≥1 problem with their MCO in the last year. Adjusted odds that adults in IPA/network or staff/group HMOs reported delays in getting needed care, not receiving the most appropriate or needed care, and being forced to change doctors were higher than for adults in PPOs. Adjusted odds that adults in IPA/network HMOs reported difficulty getting a referral to a specialist and difficulty selecting a doctor or hospital were higher than for adults in PPOs and staff/group HMOs. Adjusted odds that adults in staff/group HMOs reported misunderstandings over benefits and coverage; important benefits not covered; and problems with claims, billing, or payments were lower than for adults in PPOs and IPA/network HMOs. Adjusted odds that consumers in HMOs in our sample reported any problem with their health plan was higher for those in IPA/network HMOs compared with staff/group HMOs. No differences were seen by MCO type in the rates at which consumers reported being denied care or treatment, forced to change medications, or language and communication barriers. Conclusions. Rates at which consumers report problems with managed care and the kinds of problems they report differ significantly across different types of MCOs. These findings have important implications for federal and state policy for consumer protections in managed care.
Marc W. Zodet - One of the best experts on this subject based on the ideXlab platform.
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Methods for analyzing referral patterns
Journal of General Internal Medicine, 1999Co-Authors: Mark E. Cowen, Marc W. ZodetAbstract:OBJECTIVE: To develop a sound method to identify patient and physician characteristics that influence specialty referrals. DESIGN: A retrospective cohort analysis of medical claims data from 1996 supplemented with surveys of primary care physicians. SETTING: A 600-member Independent Practice Association in southeastern Michigan that provided care for 90,000 members of an HMO. PATIENTS: Five cohorts, each of 2,000 to 6,000 patients with diagnoses that could be referred to cardiologists, ophthalmologists, pulmonologists, orthopedists, or general surgeons. MAIN RESULTS: The referral rates for the different cohorts ranged from 1% to 7%. The discriminatory ability of the multivariate logistic models ( c -statistic) ranged from 0.66 to 0.79. The likelihood of referral was associated with the patient’s diagnoses and medications and with the referring physician’s age, years out of medical school, satisfaction with the specialty being referred to, and the importance of making or confirming a diagnosis. CONCLUSIONS: Because these methods were not difficult to implement and the results were credible, we believe that other organizations should be able to use them.
