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At least 1,099 records · Page 61Linked to original sources
PubMed1999

Who leaves managed behavioral health care?

The growth of managed care and the possibility of biased enrollment and dis-enrollment rates have raised concerns about cost shifting. This article analyzes the duration of continuous enrollment in a managed behavioral health organization among members with and without behavioral health care utilization and among members with different mental health conditions. Eleven large employers with more than 250,000 members who are enrolled in managed behavioral health plans are studied. Compared to managed care 10 years ago, the rate of dis-enrollment among patients with depression appears to have dropped. Moreover, there appear few differences in dis-enrollment among users and nonusers of behavioral health services, except for employees for whom coverage is linked to job performance. However, patients with substance abuse problems or severe types of disorders are significantly more likely to dis-enroll than patients with less severe problems.

Adolescent↗
PubMed1999

Florida's Medicaid mental health carve-out: lessons from the first years of implementation.

Florida, like many other states, has embarked on an experiment with managed mental health care for Medicaid enrollees. Under a 1915(b) waiver, the state's Medicaid agency began a mental health carve-out demonstration in March 1996 in the Tampa Bay area. This qualitative case study seeks to ascertain the impact of the carve-out (and, by comparison, HMO arrangements) on the public mental health sector. Findings suggest that the carve-out demonstration has succeeded in creating a fully integrated mental health delivery system with financial and administrative mechanisms that support a shared clinical model. However, other findings raise concerns about the HMO model in terms of stability, access to care, efficiency, and more generally about the shifting of risk and public responsibility "downstream" to private organizations without sufficient governmental oversight. These findings may offer guidance for other states implementing major managed care policy initiative for disabled Medicaid enrollees.

Behavior Therapy↗
PubMed1999

The economic impact of capitated care for high utilizers of public mental health services: the Los Angeles PARTNERS program experience.

Los Angeles PARTNERS, or "people achieving rehabilitation together need empowering respectful support," is a treatment program that uses capitation to shift risk for treatment costs of high utilizers of public mental health services to private community-based treatment organizations. This analysis reveals two important findings from PARTNERS. First, the economic incentives created by capitation contributed to the dis-enrollment of PARTNERS clients; furthermore, factors such as not speaking English or Spanish or having schizophrenia increased the probability of dis-enrollment. Second, analyses of health costs for enrollees in the PARTNERS capitation program suggest that the program did not result in a change in total costs. However, the program increased the use of community-based care and increased treatment costs for clients with lower preprogram costs but decreased costs for the clients with high preprogram costs. These results suggest that future capitation programs for this severely ill population would benefit from using detailed clinical information to determine program eligibility and to set risk-adjusted capitation rates.

Capitation Fee↗
PubMed2000

What happens when capitated behavioral health comes to town? The transition from the Fort Bragg demonstration to a capitated managed behavioral health contract.

Capitated managed care contracts for behavioral health services are becoming more prevalent across the country in both public and private sectors. This study followed the transition from a demonstration project for child mental health services to a capitated managed behavioral health care contract with a for-profit managed care company. The focus of the study was on the impact--at both the service system and the individual consumer level--pertaining to the start-up and maintenance of a capitated managed behavioral health program. A case study using multiple methods and multiple sources of information incorporated a program fidelity framework that examined micro to macro levels of program implementation. The findings of this study include the following: access to services decreased, the lengths of stay and average daily census in the more intensive levels of treatment declined, difficult-to-treat children were shifted to the public sector, and ratings of service system performance and coordination fell.

Adolescent↗
PubMed2006

Establishing a laparoscopic bariatric program in a safety net hospital.

BACKGROUND: Most laparoscopic bariatric programs are situated in a community- or university-based hospital. The authors have recently initiated a program at a safety net hospital. This investigation hypothesizes that a laparoscopic bariatric program can be established at a safety net hospital with good clinical and financial results. METHODS: A laparoscopic bariatric program was initiated December 2002 at a safety net hospital. The program included a dedicated operative suite, an operative team, a bariatric unit, and a clinical pathway. The data for all the patients who underwent laparoscopic gastric bypasses up to June 2003 were analyzed. The patients were analyzed by type of insurance: government-sponsored insurance (G) or commercial insurance (C). RESULTS: There were 104 patients during this period. Their mean age was 40 years (range, 18-63 years), and their mean body mass index was 48 (range, 38-62). The median length of hospital stay was 2 days (mean, 3.9 days). Hypertension and diabetes were resolved for more than 80% of the patients. The average percentage of excess body weight loss was 73% after 1 year. There were no significant clinical differences between payor groups. The payor mix was 31% G and 69% C. The mean collection rates for hospital charges were 10% for G versus 53% for C (p < 0.0001). CONCLUSIONS: A laparoscopic bariatric program can be established in a safety net hospital with good clinical results. Findings showed that 1-year weight loss and comorbidity improvement/resolution compares favorably with those of other programs. Despite the overall poor payor mix of many safety net hospitals, a bariatric program can be established and can attract a high rate of commercially insured patients.

Adult↗
PubMed2006

Medicare payment changes and nursing home quality: effects on long-stay residents.

The Balanced Budget Act of 1997 dramatically changed the way that Medicare pays skilled nursing facilities, providing a natural experiment in nursing home behavior. Medicare payment policy (directed at short-stay residents) may have affected outcomes for long-stay, chronic-care residents if services for these residents were subsidized through cost-shifting prior to implementation of Medicare prospective payment for nursing homes. We link changes in both the form and level of Medicare payment at the facility level with changes in resident-level quality, as represented by pressure sores and urinary tract infections in Minimum Data Set (MDS) assessments. Results show that long-stay residents experienced increased adverse outcomes with the elimination of Medicare cost reimbursement.

Aged↗
PubMed2006

The impact of government decentralization on county health spending for the uninsured in California.

We analyze Program Realignment, California's 1991 policy of decentralizing control of health, mental health, and social services, from the state to the counties. Drawing from the economics literature on intergovernmental transfers and using data constructed for this study, we analyze the impact of Realignment on uninsured health spending. We find a change in the pattern of spending on indigent health services by counties following decentralization. Our results suggest, however, that county-level governments maintain a level of commitment to social-service spending that recent studies indicate may be lacking at the state level.

California↗
PubMed1985

Capacity planning in service operations: the case of hospital outpatient facilities.

This paper presents models that may be used to balance service capacity and demand in situations in which demand is external and, therefore, is not fixed but may fluctuate in response to factors that include the waiting time imposed upon customers. Such situations are common in retailing, financial services, health services, and other service sector industries. An application is shown to a hospital outpatient facility.

Appointments and Schedules↗
PubMed1991

Forum for debate.

Explore the source record for details and available documents.

Cost Allocation↗
PubMed1991

The neurosciences and neurosurgery.

Enhancing the time-honored bonds between the neurosciences and neurosurgery is essential. The basic neurosciences are the foundation upon which fundamental scientific training and clinical research depend. Together these form the resource essential to improving the public health. Both now face severe restraints in the support systems available to them, limited degrees of reciprocity, and uncertain human resources. It is critical that the neurosurgical and neuroscience communities renew and enhance their joint commitment and trust so that both can more effectively work together to secure resources appropriate to maintaining the cutting edge on behalf of the public health.

Cost Allocation↗
PubMed1990

Comparison of short-term and continuous chemotherapy (mitozantrone) for advanced breast cancer.

132 patients with advanced recurrent breast cancer were treated with four courses of mitozantrone 14 mg/m2 intravenously every 3 weeks (9 weeks). Patients showing disease stabilisation or objective response were randomised to stop chemotherapy or to continue until disease progression. At that stage 27% showed partial responses, 3% complete responses, and 10% disease stabilisation. 22 patients were randomised to continue chemotherapy and 21 to stop. There was no difference in time to disease progression, response duration, or survival between the two groups. Toxicity was mild during the first four courses of therapy. Thus, short courses of single-agent chemotherapy can produce similar therapeutic results to long-term chemotherapy, which has major implications for cost, resource allocation, and toxicity of therapy. Stopping chemotherapy early in responders did not cause rapid relapse. Since drug resistance apparently develops early during therapy, new approaches to modify resistance should be more useful than continuous chemotherapy.

Adult↗
PubMed1987

Commercial insurers and all-payer regulation. Evidence on hospitals' responses to financial need.

This study explores commercial insurers' claims about cost-shifting in the broader context of hospitals' responses to revenue needs. It relies on hospital survey data from 1980 and 1982, a period that pre-dates Medicare's Prospective Payment System (PPS) for hospitals. While we find that limited amounts of cost-shifting occur, evidence does not support the notion that it is a perfect safety valve to control financial status. In addition, all-payer rate-setting does not appear to be related to hospitals' ability to shift costs. Instead, inpatient rate controls cause hospitals to contain costs, seek greater outpatient revenues and accept lower margins. Are the financial 'stresses' associated with PPS sufficient enough to kick off renewed concerns about cost-shifting? Some aggregate data from the PPS-era indicates that lower growth in Medicare payments has not resulted in cost-shifting on a widespread basis.

Cost Allocation↗
PubMed1990

A model of capitation.

This paper presents a theoretical model of capitation contracts. The consumer's ex ante choice of medical plan is derived under flexible assumptions about provider-patient decision-making. The optimal medical plan is shown to combine full insurance with a provider payment system that is a mixture of capitation and partial reimbursement of provider costs. This solution strongly parallels the 'mixed payment' system derived by Ellis and McGuire (1986, 1990) in the context of prospective payment, though the optimal medical plan derived below may in fact be preferred to that solution in a world with endogenous admissions.

Capitation Fee↗
PubMed1990

Using hospital-specific costs to improve the fairness of prospective reimbursement.

Payment rates in Medicare's Prospective Payment System (PPS) are based on averages of historical hospital costs. Compared to reimbursing each hospital's own costs, pricing at the average of costs implies a massive redistribution of payments among hospitals. Because not all sources of hospital costs are accounted for in the PPS, some of this redistribution is 'unfair'. Information in hospital-specific costs on unmeasured patient severity and input prices can be exploited to reduce payment inequities. However, fully hospital-specific rates are not optimal because costs also reflect treatment intensity and efficiency differences among hospitals.

Cost Allocation↗