The Experts below are selected from a list of 113769 Experts worldwide ranked by ideXlab platform
Daniel Mccaffrey - One of the best experts on this subject based on the ideXlab platform.
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effect of a large managed care program on emergency department use results from the champus reform initiative evaluation
Annals of Emergency Medicine, 1998Co-Authors: Richard L Kravitz, Jack Zwanziger, Susan D Hosek, Suzanne Polich, Elizabeth M Sloss, Daniel MccaffreyAbstract:Abstract Study Objective: To determine the effect of the CHAMPUS Reform Initiative (CRI) on emergency department use and charges, and to ascertain whether any reductions were concentrated among repeat users of the ED, those with less serious ED diagnoses, or those with selected chronic medical conditions. Methods: Participants were approximately 1.2 million beneficiaries of the Civilian Health and Medical Program of Uniformed Services (CHAMPUS) residing within either 11 military hospital catchment areas in California and Hawaii ("demonstration areas") or 11 matched control areas in other parts of the United States. Under CRI, participants were offered a choice of the standard CHAMPUS indemnity Plan, a Preferred Provider Organization– type Plan, or a network-model Health Maintenance Organization Plan. Beneficiaries were encouraged to use alternatives to the ED for nonemergency conditions. Visits to civilian EDs during two 12-month periods, before and after institution of CRI, were compared. Results: Under CRI, the number of CHAMPUS ED visits decreased by approximately 40% relative to the control, and allowed charges fell by almost 50%. Relative reductions in ED use under CRI were seen among both frequent and infrequent users of the ED. ED case-mix severity increased modestly relative to control (+3.5% versus +.9%). ED use among patients with diabetes, hypertension, and asthma fell sharply in the demonstration areas (by 14% to 41%) but rose in control areas (by 4% to 9%). Conclusion: In one of the largest managed care demonstrations ever conducted, a nonintrusive use management program and improved access to outpatient care appeared to reduce ED use, allowed charges, and costs to the government. Reductions in ED use were concentrated to some extent among repeat users and patients with less severe illnesses and were effected without capitation of provider groups or strict gatekeeping requirements. [Kravitz RL, Zwanziger J, Hosek S, Polich S, Sloss E, McCaffrey D: Effect of a large managed care program on emergency department use: Results from the CHAMPUS reform initiative evaluation. Ann Emerg Med June 1998;31:741-748.]
Kari L Olson - One of the best experts on this subject based on the ideXlab platform.
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out of Plan pharmacy use by members of a managed care Organization
The Permanente Journal, 2012Co-Authors: Thomas Delate, Gale Albrecht, Kari L OlsonAbstract:Background: Bargain generic programs have proliferated rapidly since 2006. Little is known about the use of these programs. The purpose of this study was to assess the rate and characteristics of prescriptions written in a managed care Organization (MCO) to an out-of-Plan pharmacy (OOPP). Methods: This retrospective health services investigation examined characteristics of patients in an MCO who did and did not have a prescription written to an OOPP from October 1, 2006 through September 30, 2010, and patients who had a prescription transferred to an OOPP in September 2008 (only month with data available). Descriptions of the longitudinal rate of OOPP use, OOPP patient and medication characteristics, and OOPPs where prescriptions were transferred are reported. Patient characteristics independently associated with an OOPP prescription were analyzed with logistic regression modeling. Results: A total of 10,353,283 prescriptions were included. The monthly rate of OOPP usage during the study period increased from 1.5% to 5.2% and then stabilized at around 5%. Prescriptions written to an OOPP were more likely to be for chronic disease states. Patient age and MCO termination were associated with having a prescription written to an OOPP; whereas increasing medication purchases, a drug benefit, and a health maintenance Organization Plan type were associated with not having a prescription written to an OOPP. More than 80% of transferred prescriptions went to an OOPP with a bargain generic program. Conclusion: The rate of OOPP prescriptions increased rapidly over the study period. Prescriptions written to an OOPP were predominantly for chronic diseases. Further research is warranted to assess if OOPP use results in reduced quality of health care system oversight or compromises patient health.
Richard L Kravitz - One of the best experts on this subject based on the ideXlab platform.
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effect of a large managed care program on emergency department use results from the champus reform initiative evaluation
Annals of Emergency Medicine, 1998Co-Authors: Richard L Kravitz, Jack Zwanziger, Susan D Hosek, Suzanne Polich, Elizabeth M Sloss, Daniel MccaffreyAbstract:Abstract Study Objective: To determine the effect of the CHAMPUS Reform Initiative (CRI) on emergency department use and charges, and to ascertain whether any reductions were concentrated among repeat users of the ED, those with less serious ED diagnoses, or those with selected chronic medical conditions. Methods: Participants were approximately 1.2 million beneficiaries of the Civilian Health and Medical Program of Uniformed Services (CHAMPUS) residing within either 11 military hospital catchment areas in California and Hawaii ("demonstration areas") or 11 matched control areas in other parts of the United States. Under CRI, participants were offered a choice of the standard CHAMPUS indemnity Plan, a Preferred Provider Organization– type Plan, or a network-model Health Maintenance Organization Plan. Beneficiaries were encouraged to use alternatives to the ED for nonemergency conditions. Visits to civilian EDs during two 12-month periods, before and after institution of CRI, were compared. Results: Under CRI, the number of CHAMPUS ED visits decreased by approximately 40% relative to the control, and allowed charges fell by almost 50%. Relative reductions in ED use under CRI were seen among both frequent and infrequent users of the ED. ED case-mix severity increased modestly relative to control (+3.5% versus +.9%). ED use among patients with diabetes, hypertension, and asthma fell sharply in the demonstration areas (by 14% to 41%) but rose in control areas (by 4% to 9%). Conclusion: In one of the largest managed care demonstrations ever conducted, a nonintrusive use management program and improved access to outpatient care appeared to reduce ED use, allowed charges, and costs to the government. Reductions in ED use were concentrated to some extent among repeat users and patients with less severe illnesses and were effected without capitation of provider groups or strict gatekeeping requirements. [Kravitz RL, Zwanziger J, Hosek S, Polich S, Sloss E, McCaffrey D: Effect of a large managed care program on emergency department use: Results from the CHAMPUS reform initiative evaluation. Ann Emerg Med June 1998;31:741-748.]
Andrew Ballard - One of the best experts on this subject based on the ideXlab platform.
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structure of the physical therapy benefit in a typical blue cross blue shield preferred provider Organization Plan available in the individual insurance market in 2011
Physical Therapy, 2013Co-Authors: Robert W Sandstrom, Jedd Lehman, Lee Hahn, Andrew BallardAbstract:Background The Affordable Care Act of 2010 establishes American Health Benefit Exchanges. The benefit design of insurance Plans in state health insurance exchanges will be based on the structure of existing small-employer–sponsored Plans. Objective The purpose of this study was to describe the structure of the physical therapy benefit in a typical Blue Cross Blue Shield (BCBS) preferred provider Organization (PPO) health insurance Plan available in the individual insurance market in 2011. Design A cross-sectional survey design was used. Methods The physical therapy benefit within 39 BCBS PPO Plans in 2011 was studied for a standard consumer with a standard budget. First, whether physical therapy was a benefit in the Plan was determined. If so, then the structure of the benefit was described in terms of whether the physical therapy benefit was a stand-alone benefit or part of a combined-discipline benefit and whether a visit or financial limit was placed on the physical therapy benefit. Results Physical therapy was included in all BCBS Plans that were studied. Ninety-three percent of Plans combined physical therapy with other disciplines. Two thirds of Plans placed a limit on the number of visits covered. Limitations The results of the study are limited to 1 standard consumer, 1 association of insurance companies, 1 form of insurance (a PPO), and 1 PPO Plan in each of the 39 states that were studied. Conclusions Physical therapy is a covered benefit in a typical BCBS PPO health insurance Plan. Physical therapy most often is combined with other therapy disciplines, and the number of covered visits is limited in two thirds of Plans.
Thomas Delate - One of the best experts on this subject based on the ideXlab platform.
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out of Plan pharmacy use by members of a managed care Organization
The Permanente Journal, 2012Co-Authors: Thomas Delate, Gale Albrecht, Kari L OlsonAbstract:Background: Bargain generic programs have proliferated rapidly since 2006. Little is known about the use of these programs. The purpose of this study was to assess the rate and characteristics of prescriptions written in a managed care Organization (MCO) to an out-of-Plan pharmacy (OOPP). Methods: This retrospective health services investigation examined characteristics of patients in an MCO who did and did not have a prescription written to an OOPP from October 1, 2006 through September 30, 2010, and patients who had a prescription transferred to an OOPP in September 2008 (only month with data available). Descriptions of the longitudinal rate of OOPP use, OOPP patient and medication characteristics, and OOPPs where prescriptions were transferred are reported. Patient characteristics independently associated with an OOPP prescription were analyzed with logistic regression modeling. Results: A total of 10,353,283 prescriptions were included. The monthly rate of OOPP usage during the study period increased from 1.5% to 5.2% and then stabilized at around 5%. Prescriptions written to an OOPP were more likely to be for chronic disease states. Patient age and MCO termination were associated with having a prescription written to an OOPP; whereas increasing medication purchases, a drug benefit, and a health maintenance Organization Plan type were associated with not having a prescription written to an OOPP. More than 80% of transferred prescriptions went to an OOPP with a bargain generic program. Conclusion: The rate of OOPP prescriptions increased rapidly over the study period. Prescriptions written to an OOPP were predominantly for chronic diseases. Further research is warranted to assess if OOPP use results in reduced quality of health care system oversight or compromises patient health.