Managed Care
AHCPR Research About Managed Care
AHRQ Tools for Managed Care
Cultural Competence Guides for Managed Care Plans
Integrated Delivery System Research Network (IDSRN)
Managed Care Features and Chronic Conditions: Effects
on Quality of Care and Patient Outcomes
Strengthening Managed Care
Conferences and Meetings
AHCPR Workshop on
Carve-Outs
Building Bridges
IV: Improving the Public's Health Through Research
Partnerships
Health Care
Markets and Managed Care: New Evidence and Emerging Issues
Health Care
Markets and Managed Care: Expert Meeting to Discuss Emerging
Research Priorities
HMO Research
Network National Conferences
User Liaison Program Workshop Summaries
Assessing Roles,
Responsibilities, and Activities in a Managed Care Environment—A
Workbook for Local Health Officials
Integrated Delivery
Systems In Managed Care: Challenges to State Oversight
Local Health Departments in a Managed Care Environment: Challenges and
Opportunities
Managed Care and
Persons with Disabilities and Chronic Illnesses
Providing
High-Quality Services to Children with Special Health Care Needs
Under Managed Care
Managing Care for Adults with Chronic Conditions
Strengthening the
Rural Health Infrastructure: Network Development and Managed Care
Strategies
Structuring Health
Insurance Markets: Protecting Consumers and Promoting
Competition
Understanding the
Alphabet Soup of Managed Care Integrated Delivery Systems
Workers'
Compensation and Managed Care: Challenges and Opportunities in a
Changing Health Care System
Research Findings
Research Activities, May 2004:
Jaundice and feeding problems are not associated with short hospital stays, as long as newborns are evaluated at 3 or 4 days of life
Health care costs are lower in Minnesota than in other States due mostly to structural factors, not financial incentives
Young and healthy individuals fare better than moderately sick individuals with consumer-directed health benefits
Greater HMO penetration in an area reduces the number of preventable hospitalizations
Research Activities, April 2004:
Medicare enrollees in for-profit plans are no less likely to receive high-cost procedures than those in non-profit plans
Health plan use of gatekeepers may improve use of recommended cancer screening
Research Activities, March 2004:
Researchers examine the management of chronic illness in managed care settings
Research Activities, February 2004:
Being a salaried physician in a large office may be the chief source of physician dissatisfaction with managed care
Some managed care strategies to improve drug use appear to be effective, but little is known about long term clinical outcomes
Research Activities, December 2003:
Among children with asthma, those enrolled in Medicaid managed care fare better than those in a primary care case manager plan
One form of managed care was associated with declines in physician participation in Georgia and Alabama Medicaid programs
Research Activities, November 2003:
California HMOs rely on informal evaluations of quality, not hospital report cards, to select hospitals for contracting
Lack of insurance and living in an area with greater managed care activity reduce access to care
Managed care patients' concerns about conflict of interest may be harming their relationship with their doctors
Research Activities, October 2003:
Managed care patients with glaucoma are receiving recommended care, but care could be improved in a few areas
Research Activities, September 2003:
Managed care plans rarely deny reimbursement for hospital care
Research Activities, July 2003:
Children in U.S. managed care plans are far more likely to be referred to specialists than children in the United Kingdom
Research Activities, May 2003:
Capitated payments and gatekeeping practices have minor effects on referrals of managed care patients to specialists
Patient characteristics and insurance coverage affect their ratings of managed behavioral health care plans
Medicare plan quality information doesn't prompt people to switch from traditional to HMO plans or to choose low-cost HMOs
Research Activities, April 2003:
Most appeals to managed care health plans dispute provider choice and contractual coverage, not medical necessity
Research Activities, March 2003:
States vary widely in how they regulate private health insurers and managed care organizations
Research Activities, February 2003:
Researchers examine access to care and quality for Medicaid MCO enrollees who have disabilities
Managed care appears to reduce disparities in the use of preventive care for some racial/ethnic groups
Research Activities, January 2003:
Study in large HMO found that infants discharged 1 day after birth fared as well as those with longer hospital stays
Adding CAHPS® data to standard enrollment materials does not affect health plan choice among new Medicaid enrollees
Research Activities, December 2002:
Managed care's selective contracting with physicians slowed growth in physician fees during the early 1990s
Provider-sponsored managed care organizations work best when community leaders and health professionals are involved
Research Activities, October 2002:
Anticoagulation services are feasible in a managed care setting but show little clinical effect
Managed care's reliance on supply-side control of services does not necessarily eliminate least valued treatment
Some State Medicaid managed care programs have policies that could restrict access to needed medications
Managed care organizations should consider patients' socioeconomic status when profiling a physician's performance
Increasing the cultural competence of health care organizations can make business sense
Research Activities, July 2002:
Fee-for-service Medicare plans offer better quality care than Medicare HMO plans, but costs are higher
Researchers examine impact of managed care on the U.S. health care system, local health care markets, and specialty care
Research Activities, March 2002:
State shifts to Medicaid managed care may limit poor patients' access to specialists
Rural hospitals are more likely to pursue managed care strategies in highly competitive markets
Researchers examine ways to assess the quality of care provided by preferred provider organizations
Research Activities, January 2002:
HMO market penetration does not account for poorer financial performance of public compared with private hospitals
Research Activities, December 2001:
Managed care cost-containment policies strengthen continuity of primary care for depressed patients
Case management appears to be associated with fewer unmet needs among people with HIV infection
Medicare fee-for-service patients seem to fare better in areas of higher HMO market penetration
Research Activities, August 2001:
Proposed antitrust exemption for physicians may alter the balance of power between doctors and health plans
Research Activities, July 2001:
Study finds no differences in heart attack followup care provided to Medicare fee-for-service and HMO patients, but effective drugs are underprescribed for both
Doctors' dissatisfaction grew steadily over the last decade
Research Activities, May 2001:
Medicaid managed care programs decreased the likelihood of repeat c-sections during the 1990s
Research Activities, April 2001:
HMOs should adjust their use of inhaled anti-inflammatory medicines for asthma patients to meet national guidelines
Treating more Medicaid managed care patients in community health centers may reduce care for uninsured patients
Research Activities, January 2001:
Not all types of HMOs benefit financially from so-called "selection bias"
Acquisition of local nonprofit hospitals by regional hospital systems may weaken community control of local hospital pricing
Research Activities, November 2000:
Coronary angiography is underused for both Medicare managed care and fee-for-service heart attack patients
Researchers examine physicians' perceptions of health plan incentives to limit services
Research Activities, August 2000:
Patients often do not understand information about the financial incentives offered to physicians by insurers
Research Activities, June 2000:
Direct access to specialists may not raise managed care plans' costs
Managed care organizations make only limited use of New York State data on cardiac surgery mortality rates
Hospitals often form alliances with physicians when the number of HMOs in an area increases
Responses to current health care system changes are largely reactive and as fragmented as the changes themselves
Exportation of managed care to third-world countries may be detrimental rather than advantageous to their health
Research Activities, May 2000:
Consumers'
assessments of Medicare managed care plans can distinguish different
dimensions of quality of care
Differences
in hospital admission rates between managed care and other insurers
leveling off
Most
midcareer physicians object to cost-control arrangements that
influence clinical decisionmaking
Research Activities, January 2000:
Income
for most physicians has declined substantially since the advent of
HMOs
Strategic
hospital alliances have yet to add financial value to individual
member hospitals
Nation's
move toward managed care challenges academic health centers to
sustain research and training
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