Objective: To evaluate the relationship between adherence to antidepressant therapy and economic outcomes. Design: Retrospective database analysis using pharmacy and medical claims from a pharmacy benefit and medical management company serving a large managed care organization (MCO) that...

Background:Background: Many Medicaid programmes now offer behavioural healthcare through managed care organizations. Medicaid programmes are concerned about carve-outs because the use of non-included services may rise, limiting the efficiencies anticipated with the implementation of managed...

Disease state management (DSM) is a new concept in healthcare which is rapidly growing in terms of interest and potential as an effective approach to improving patient outcomes. The term DSM refers to a `systematic population-based approach to identify persons at risk, intervene with specific...

Objective: To evaluate a pneumonia disease management programme in a naturalistic setting. Design and Setting: A 300 000 member managed-care organisation introduced an antibacterial treatment guideline designed to change antibacterial prescribing by physicians. A relational database was created...

From 1 January 1999, all requests by pharmaceutical manufacturers and others to Blue Cross and Blue Shield (BCBS) of Colorado and Nevada for the listing of new pharmaceutical products or any proposed change to the formulary status of an existing product must be accompanied by a submission which...

Objective: Disease management can be described as a data-driven care process across the continuum from symptom perception through to diagnosis and treatment. In order to effectively manage this medical-care process, the practitioner must understand the epidemiology of the disease, and nature of...

Background: One particularly difficult challenge in evaluating disease management (DM) programs is defining the scope of economic outcomes to include in the evaluation. Measuring `all-cause utilization' or `total costs' assumes that a DM intervention impacts the entire spectrum of services...

Asthma is a chronic condition with characteristics that make it an ideal target for interventions used within disease state management in managed care settings. It affects a substantial population of patients and imposes an increasingly significant global societal burden. Despite the...

Population-based risk adjustment, as applied to reimbursement in managed care settings, may reduce pressures for adverse selection by managed care organisations. Using insurance claims data from 184

This article describes 3 approaches to improving diabetes care in a health maintenance organisation (HMO) setting. The first approach was to identify which patients had not received a dilated eye examination in the past year, notify both them and their physician, and provide each with...