Measuring the "managedness" and covered benefits of health plans (original) (raw)

Managed care and traditional insurance: Comparing quality of care

International Social Security Review, 2003

The article compares quality of care under the traditional "fee-for-service" system with that given by "managed care" providers in the United States. Outcomes have been mixed, with most studies reporting on one hand a decline in the propensity of patients of health maintenance organizations (HMOs) to seek treatment and, on the other, lower patient satisfaction. The quality of care has not deteriorated, however, except in the case of that given to vulnerable patients. Historical background The earliest programmes of health insurance in the United States offering care to a specified population in return for a fixed premium paid in advance by the individual 1 made their appearance at the beginning of the twentieth century. These, some of them still in existence today (Blue Shield and Blue Cross), include Dr. Michael Shadid's cooperative health plan in Elk City, Oklahoma (1929), 2 the Ross-Loos Clinic which offered prepaid care for employees of the Los Angeles Bureau of Water and Power and their families, the Western Clinic in Tacoma (Washington state), 3 Dr.

Organizational and Financial Characteristics of Health Plans

Archives of Internal Medicine, 2000

Background: Primary care performance has been shown to differ under different models of health care delivery, even among various models of managed care. Pervasive changes in our nation's health care delivery systems, including the emergence of new forms of managed care, compel more current data.

Quality of Care in Medicaid Managed Care and Commercial Health Plans

JAMA, 2007

Context In contrast to the commercially insured population, the proportion of Medicaid beneficiaries enrolling in health maintenance organizations continues to increase. Objective To compare quality of care within and between the Medicaid and commercial populations in 3 types of managed care plans: Medicaid-only plans (serving predominantly Medicaid enrollees), commercial-only plans (serving predominantly commercial enrollees), and Medicaid/commercial plans (serving substantial numbers of both types of enrollees). Design, Setting, and Participants All 383 health plans that reported quality-ofcare data to the National Committee for Quality Assurance for 2002 and 2003, including 204 commercial-only plans, 142 Medicaid/commercial plans (plans reported data for the Medicaid and commercial populations separately); and 37 Medicaid-only plans. Main Outcome Measures Eleven quality indicators from the Healthcare Effectiveness Data and Information Set (HEDIS) applicable to the Medicaid population. Results Among Medicaid enrollees, performance on the 11 measures observed in this study were comparable for Medicaid-only plans and Medicaid/commercial plans. Similarly, among commercial enrollees, there was virtually no difference in performance between health plans that served only the commercial population and those that also served the Medicaid population. Overall across all health plan types, the performance for the commercial population exceeded the performance for the Medicaid population on all measures except 1, ranging from a difference of 4.9% for controlling hypertension (58.4% for commercial vs 53.5% for Medicaid; P=.002) to 24.5% for rates of appropriate postpartum care (77.2% for commercial vs 52.7% for Medicaid; P=.001). Differences of similar magnitude were observed for commercial and Medicaid populations treated within the same health plan. Conclusions Medicaid managed care enrollees receive lower-quality care than that received by commercial managed care enrollees. There were no differences in quality of care for the Medicaid population between Medicaid-only plans and commercial plans that also served the Medicaid population.

A National Survey of the Arrangements Managed-Care Plans Make with Physicians

New England Journal of Medicine, 1995

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 independentpractice-association (IPA) HMOs, and 29 were preferred-provider organizations (PPOs). Results. Respondents from all three types of plan said