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Biomedical subjects

T Lake

Publications and source records attributed to T Lake.

12 recordsLinked to original sources
PubMed2000

Do HMOs make a difference?

The growth of managed care has prompted questions about the effects of health maintenance organizations (HMOs) on consumers. This Issue Brief reports the results from a large national study of the privately insured population. No detectable difference was found between HMOs and other types of insurance in the use of three costly services--inpatient care, emergency room use and surgeries--and differences in reports of unmet need or delayed care are negligible. Differences for other measures pose a trade-off for consumers: HMOs provide more primary and preventive services and lower financial barriers to care, but they provide less specialist care and raise administrative barriers to care. In addition, patients in HMOs report less satisfaction, less trust in physicians and lower ratings of physician visits. These findings have implications for the current policy debate about managed care.

Community Participation↗
PubMed1998

Current trends in health plan payment methods for the facility costs of outpatient care.

Outpatient hospital and ambulatory care services represent the fastest growing part of national health care expenditures. Until recently, most health plans reimbursed providers' outpatient facility costs on the basis of billed charges. Some health plans have now implemented prospective payment systems with incentives for limiting the volume of ambulatory care services. Findings from 1997 telephone interviews with senior managers in national managed care companies and local health plans reveal that recent reforms at some health plans have been generally incremental, building on existing systems, but use of outpatient prospective payment systems by private health plans is still rare. However, health plan managers expect continued reforms in the future as experience is gained with new payment systems such as those based on the Ambulatory Patient Groups case mix grouping method.

Ambulatory Care↗
PubMed1995

A national survey of the arrangements managed-care plans make with physicians.

BACKGROUND: Despite the growth of managed care in the United States, there is little information about the arrangements managed-care plans make with physicians. METHODS: In 1994 we surveyed by telephone 138 managed-care plans that were selected from 20 metropolitan areas nationwide. Of the 108 plans that responded, 29 were group-model or staff-model health maintenance organizations (HMOs), 50 were network or independent-practice-association (IPA) HMOs, and 29 were preferred-provider organizations (PPOs). RESULTS: Respondents from all three types of plan said they emphasized careful selection of physicians, although the group or staff HMOs tended to have more demanding requirements, such as board certification or eligibility. Sixty-one percent of the plans responded that physicians' previous patterns of costs or utilization of resources had little influence on their selection; 26 percent said these factors had a moderate influence; and 13 percent said they had a large influence. Some risk sharing with physicians was typical in the HMOs but rare in the PPOs. Fifty-six percent of the network or IPA HMOs used capitation as the predominant method of paying primary care physicians, as compared with 34 percent of the group or staff HMOs and 7 percent of the PPOs. More than half the HMOs reported adjusting payments according to utilization or cost patterns, patient complaints, and measures of the quality of care. Ninety-two percent of the network or IPA HMOs and 61 percent of the group or staff HMOs required their patients to select a primary care physician, who was responsible for most referrals to specialists. About three quarters of the HMOs and 31 percent of the PPOs reported using studies of the outcomes of medical care as part of their quality-improvement programs. CONCLUSIONS: Managed-care plans, particularly HMOs, have complex systems for selecting, paying, and monitoring their physicians. Hybrid forms are common, and the differences between group or staff HMOs and network or IPA HMOs are less extensive than is commonly assumed.

Capitation Fee↗
PubMed1995

Behind the curve: a critical assessment of how little is known about arrangements between managed care plans and physicians.

Extraordinary growth in managed care arrangements over the past decade has been both widely praised and criticized. Proponents and critics agree that the nature of medical practice is being profoundly altered by this growth, even if they cannot articulate the direction and consequences of this change. We explore the roots of this uncertainty by examining the available evidence on critical features of the arrangements managed care plans currently have with affiliated physicians. Our approach is to review and synthesize the literature in several key substantive areas from a broad range of sources. We found that existing knowledge is dated, derived form a limited subset of plans, inattentive to important structural differences between plans, and responsive to a very narrow set of issues poorly reflecting the range of medical practice and change introduced by managed care. We highlight key questions of interest and the knowledge gaps critical to address so that policy and management decisions can both reflect and be informed on these issues that define the arrangements managed care plans make with physicians and ultimately influence medical practice.

Capitation Fee↗
PubMed1987

Prolonged absorption with development of tolerance to toxic effects after cutaneous exposure to nicotine.

This report describes a patient who developed nicotine poisoning after cutaneous application of nicotine sulfate. Measurement of nicotine and metabolite levels in the blood demonstrated prolonged absorption of nicotine despite vigorous skin decontamination. This suggests that the skin may be a reservoir for slow release of nicotine into the circulation. Despite extraordinarily high levels of nicotine, the patient had full resolution of signs and symptoms of intoxication, indicating rapid and profound development of tolerance.

Administration, Topical↗
PubMedDate not supplied

Provider organizations at risk: a profile of major risk-bearing intermediaries, 1999.

Provider organizations have evolved to function as intermediaries between managed care plans and individual providers. These organizations assume much financial risk and care management responsibilities. We profile the characteristics of these organizations in markets across the country. The data, taken from a 1999 telephone survey of sixty-four entities in twenty markets and from interviews conducted during site visits to four markets, highlight the youth of many of these organizations, the large financial risk and functional responsibilities they bear, and the mixed views they hold about the health plans they contract with in terms of their willingness to delegate the authority, support, and collaboration that accompany risk. Policymakers need to evaluate what this means for oversight of managed care.

Capitation Fee↗
PubMedDate not supplied

Do HMOs make a difference? Consumer assessments of health care.

This study examines the effects of health maintenance organizations (HMOs) on consumer assessments of health care among the privately insured, nonelderly population. After controlling for population and location differences, the study finds that HMO enrollees are less likely than those in non-HMOs to be satisfied with their care, to rate their last medical visit highly, and to express trust in their physicians. One exception is a finding of little or no statistically significant difference between HMO and non-HMO enrollees in the likelihood of distrust that a physician may provide unnecessary services.

Adult↗