Episodes of care provide a clinically meaningful unit of analysis for measuring both the cost and quality of patient care. Many health plans are currently using episode of care grouping software in cost-focused provider profiling applications. These profiles compare the cost for one provider to...

Objectives: To compare the experience of one managed care organization (MCO) [Anthem Blue Cross and Blue Shield Midwest Region] to the experience of a reference group of 15 other MCOs participating in a study designed to test the usefulness of outcomes management information in developing and...

In this article, the issue of who benefits from managed drug use in assisted living and home care settings is addressed from a clinical perspective. Benefit in clinical terms is always focused on the patient as an individual and not on the system or process of providing managed drug use. Indeed,...

Increasing healthcare expenditures and other economic pressures mandate fundamental reforms of the healthcare system in Germany. The overall goal is restraint of costs while at the same time maintaining a high standard of medical care. Among all options, managed care represents a potential...

This paper studies competition between Managed Care Organizations (MCOs) and “Conventional Insurers”. Most of the time, MCOs sign exclusive contracts with providers and these vertical restrictions associated to differentiation in the providers'market imply a risk segmentation. Taking into...

We analyze the effect that competition between HMOs has on the cost and quality of medical services. Our key result is that increasing competition enhances consumer utility while also moderating the impact of managed care on quality and costs. Indeed, we find that heightened competition between...

A risk adjustment scheme (RAS) within social health insurance is designed to prevent insurers from engaging in risk selection. This paper shows that with cost differences between insurance plans as they exist between managed-care and traditional insurance, current RASs create incentives for...

Managed care, with its restrictions on patient and provider autonomy, has dominated the delivery of healthcare in the US over the last decade. The latest model of managed care has focused on disease management programs, which outline optimal cost-effective processes for care, built on...

This study identifies longitudinal psychiatric trajectories of 934 adult individuals entering chemical dependency treatment in a private, managed care health plan and examines the relationship of these trajectories with substance use (SU) outcomes. The authors apply a group-based modeling...