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Biomedical subjects

William G Weissert

Publications and source records attributed to William G Weissert.

5 recordsLinked to original sources
PubMed2006

Survival skills for the political environment of health insurance.

Blue Cross Blue Shield of Michigan asked the Michigan state government for small group market rate reform already adopted in most other states. Officials responded with major restructuring proposals aimed specifically at the Blues. The Michigan Blues fought back with a massive lobbying campaign as vigorous as any mounted by opponents of health reform at the national level. The company was able to prevail over one of the most powerful governors in Michigan history, whose party controlled both houses of the legislature. This amazing political victory shared much in common with the Clinton health reform's defeat by the industry and the more recent success of the prescription drug industry in shaping Medicare prescription drug reform to its liking. The experience suggests that political savvy and lobbying skills have become core competencies in the health care industry.

Blue Cross Blue Shield Insurance Plans↗
PubMed2003

Case management: effects of improved risk and value information.

PURPOSE: The purpose of this study was to determine the impact on resource use of providing case managers with information on the potential for patients to benefit from home care services. DESIGN AND METHODS: Twenty-four case managers working in the Arizona Long Term Care System (ALTCS) were randomized into treatment and control groups. Members of the treatment group were given patient assessments for 25 ALTCS clients, estimates of the patients' risks for various adverse outcomes, and estimates of the aggregate potential benefit for each patient. Members of the control group were given only patient assessments (as is usual practice) for the same sample of 25 clients. Both groups were asked to independently write nonbinding care plans for each patient. The cost of each case manager's care plans was computed by multiplying standard costs per service times the mix and volume of services prescribed for each patient. RESULTS: Treatment group care plan costs were, on average, lower than control group costs and closely tracked variation in estimated patient risks. Comparison group care plan costs were unrelated to risks. IMPLICATIONS: Information about risk and potential benefit can improve targeting of services to long-term-care clients. A prospective study using such an approach is warranted to see if provision of risk and potential benefit information would produce better clinical and economic outcomes.

Aged↗
PubMed2003

Strategies for integrating Medicare and Medicaid: design features and incentives.

In a typical third-party payer situation--representative of most U.S. health care delivery--the payer is likely to have interests that are at odds with the patient and provider. The separation and overlap between Medicare and Medicaid for individuals eligible for both programs introduces an additional level of complexity: multiple masters over plans, providers, and patients. This creates opportunities for shifting costs and administrative burdens between states and the federal government, providers and governments, and patients and everyone else. Program designers who wish to minimize unwanted consequences must find ways to structure their programs to produce financial incentives that encourage the pursuit of societal goals, including appropriately shared intergovernmental responsibilities and appropriate plan, provider, and patient behavior. Here the authors review nine federal and state initiatives that use varying strategies to integrate Medicare and Medicaid services for vulnerable populations. For each initiative, the authors examine and critique program design features in three areas: (1) eligibility determination, (2) finance and administration, and (3) service delivery. They find a few strengths and many weaknesses in design. Future efforts would be well served by carefully considering the incentive structures designed into these initiatives and working to improve them in the next generation of Medicare-Medicaid integration efforts.

Acute Disease↗
PubMed2003

Models, measures, and methods: variability in aging research.

The purpose of this paper is to review the models and measurement strategies used in studies evaluating the predictors of nursing home placement, hospitalization, functional impairment and mortality. To do so we examine 167 multivariate equations abstracted from 78 longitudinal studies published between 1985 and 1998 that assess the risk factors of one or more adverse outcomes. We find that both comparatively straightforward concepts such as age and income and widely used scales such as activities of daily living and the short-portable mental status questionnaire display considerable variability in operationalization and coding. We also find that few researchers employ explicit conceptual models to assist with variable choice, while some predictors-demographics, physical and cognitive functioning-were studied much more frequently than others-service, market, and policy characteristics. Variability in measurement highlights the lack of standardization in this area of aging research and leaves room for improvements in validity and reliability. Limited use of conceptual models has led researchers to include some predictors in their analyses to the exclusion of others.

Activities of Daily Living↗