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At least 487 records · Page 27Linked to original sources
PubMed1994

Janet M. Corrigan, Ph.D.. Interview by Marie E. Sinioris.

The ability of health care purchasers and consumers to make objective evaluations and comparisons of health plan performance is a critical element in achieving competition based on quality and value. The Health Plan Employer Data and Information Set, commonly referred to as HEDIS 2.0, is a step toward making such evaluations and comparisons possible. To get an inside perspective on HEDIS and its implications for health care, QMHC interviewed Janet Corrigan, Ph.D., Vice President, Planning and Development, National Committee for Quality Assurance (NCQA). Dr. Corrigan is in charge of NCQA's efforts to implement and continually improve HEDIS.

Employee Performance Appraisal↗
PubMed1995

Capitation and informatics.

When physicians, hospitals, and allied health professionals bill for services they render, their information processing requirements are relatively simple, at least compared to those of capitated organizations. When payers (insurers or employers) accept financial risk for the health care services of beneficiaries, they have usually invested in claims processing, membership tracking, and, under managed care, utilization review and provider profiling systems. But payers, for the most part, have not invested in electronic collection of clinical information about beneficiaries, nor have they tended to keep all claims they have processed in electronic form for study after accounts are settled and payments disbursed. In this article, we will explore why informatics is so important to capitated organizations and why payers that have traditionally taken financial risk for insuring the health care costs of populations are also learning about the importance of informatics.

Capitation Fee↗
PubMed1998

Integrated outcomes: where CIOs need to be thinking.

Financial data have been the mainstay in health care organization business decision making. CIOs can lead efforts to add clinical and satisfaction data and create more customer-focused integrated outcomes systems.

Data Collection↗
PubMed2003

Evaluating health plan quality 2: survey design principles for measuring health plan quality.

OBJECTIVE: To develop principles for measuring the quality of specific health plans from a physician's perspective. STUDY DESIGN: Literature review, expert review, cognitive interviews. METHODS: We did a literature review on the use of physician surveys about managed care to determine the contributions and weaknesses of those surveys. Then, an expert review of prior survey efforts to measure health plan quality from the physician's perspective was performed. RESULTS: A survey instrument based on a conceptual model of health plan quality was developed. Its purpose was to measure health plan quality from the physician's perspective. Principles for surveying physicians guided the structure of the survey. CONCLUSION: Survey instruments can be designed to take into account a physician's unique perspective on health plan quality and can include measures that control for potential biases such as anti-managed care bias.

Attitude of Health Personnel↗
PubMed1993

Medicaid case management: Kentucky's Patient Access and Care Program.

Since 1981, States have been experimenting with Medicaid managed care programs to improve access and continuity of care and to contain costs by reducing inappropriate and unnecessary utilization. To determine the impact of primary care case management (PCCM) on utilization, the authors examine data from the Kentucky Patient Access and Care program (KenPAC). Using monthly utilization data from 1984 to 1989 and an interrupted time-series research design, the authors find that PCCM reduces the use of independent laboratory, physician, emergency department, and outpatient hospital services. PCCM does not appear to affect utilization of inpatient hospital services or prescription drugs.

Health Services Accessibility↗
PubMed1996

Managed care and public health: building a partnership.

Critics today charge that managed care organizations, intent on reducing costs to ensure survival and profitability, have forsaken public health. In fact, managed care and public health face common challenges and share common interests. Public health problems ultimately affect managed care enrollees and increase the cost of their care. Managed care organizations, then, must help reduce community-wide health risks. Public health agencies, traditionally responsible for population health, today face serious challenges due to budget reductions and public indifference. The article to follow proposes a model for mutually beneficial collaboration between managed care and public health. Programs linking managed care with public health in the Puget Sound area illustrate this model's feasibility and value.

Adolescent↗