Grantee Publication

Comparing Accuracy of Risk-Adjustment Methodologies Used in Economic Profiling of Physicians

Inquiry -- September 2004
Vol. 41, No. 2
September 2004
Thomas, J.W., Grazier, K., and K. Ward
pp. 218-31

This paper examines the relative accuracy of risk-adjustment methodologies used to profile primary care physician practice efficiency. Claims and membership data from an independent practice association health maintenance organization (HMO) were processed through risk-adjustment software of six different profiling methodologies. The Group R2 statistic was used to measure, for simulated panels of HMO members, how closely each methodology's cost predictions matched the panel's actual costs.

Guaranteed Renewability and the Problem of Risk Variation in Individual Health Insurance Markets

Health Affairs Web Exclusive
Web Exclusive
September 2002
Patel, V. and M.V. Pauly
pp. W280-9

Consumers should be protected against fluctuations in premiums for private individual health insurance associated with the onset of high-cost chronic conditions. The most commonly discussed way to do so is through community rating, which provides protection but can require a heavy regulatory burden and can create incentives for adverse selection and cream skimming. This paper describes an alternative method of providing the same type of protection: insurance contract provisions that guarantee renewability for the next coverage period at class-average rates.

The Impact of Health Insurance Market Reforms on Market Competition

American Journal of Managed Care
Vol. 6, No. 1
January 2000
Hall, M.
pp. 57-67

OBJECTIVES: To assess the impact of state and federal health insurance market reforms on the nature and extent of market competition. STUDY DESIGN: Qualitative, comparative case studies in 7 states. METHODS: Two rounds of in-depth interviews were conducted with over 100 key informants from the insurance industry. In each state, these sources included 2 to 4 regulators, 5 to 6 independent agents, and several sources at each of 4 to 5 of the top insurers. Extensive documentary data relating to market activity were also collected.

Patterns of Individual Health Insurance Coverage, 1996-2000

Health Affairs-- November/December 2004
Vol. 23, No. 6
November/December 2004
Ziller, E., Coburn, A., McBride, T., and C. Andrews
pp. 210-21

Health Affairs-- November/December 2004 

Is Provider Capitation Working: Effects of Capitation on Integration and Hospital Costs of Care

Medical Care
Vol. 38, No. 3
March 2000
Bazzoli, G.J., Dynan, L., Burns, L.R., and R.C. Lindrooth
pp. 311-24

BACKGROUND: Capitation holds health providers fiscally responsible for the services they deliver or arrange and thus provides strong motivation for physicians and hospitals to integrate activities and reduce costs of care. OBJECTIVES: The objective of this study was to assess 2 potential effects of capitation: (1) its effects on the integration of functional, financial, and clinical processes between hospitals and physicians and (2) its effects, in conjunction with process integration, on hospital costs.

Switching Costs, Price Sensitivity and Health Plan Choice

Journal of Health Economics
Vol. 21, No. 1
January 2002
Strombom, B.A., Buchmueller, T.C., and P.J. Feldstein
pp. 89-116

We investigate the extent to which sensitivity to health plan premiums differs across individuals according to characteristics related to the cost of switching plans. Our results indicate substantial variation in price sensitivity related to expected health care costs: younger, healthier employees are between two and four times more sensitive to price than employees who are older and who have been recently hospitalized or diagnosed with cancer. We also find evidence of status quo bias: estimated premium elasticities are significantly higher for new hires than for incumbent employees.

Journal Article: Medicaid Managed Care and Health Care for Children

Health Services Research - October 2005
Vol. 40, No. 5, Pt. 1
October 2005
Baker, L.C. and C. Afednulis
pp. 1466–88

Objective. Many states expanded their Medicaid managed care programs during the 1990s, causing concern about impacts on health care for affected populations. We investigate the relationship between Medicaid managed care enrollment and health care for children.

Market Failures and the Evolution of State Regulation of Managed Care

Law and Contemporary Problems
Vol. 27., No. 6
Autumn 2002
Sloan, F.A. and M.A. Hall
pp. 889-925

In response to widespread dissatisfaction with managed care, states have enacted numerous statutes, known as managed care patient protection laws, that address concerns of consumers and medical care providers. These laws include (in various combinations): (1) liability and external review provisions, (2) increasing choice of and access to providers, (3) protecting providers from undue influence, and (4) setting general coverage standards and specific coverage mandates.

Evaluation of the Group Health Cooperative Access Initiative: Study Design Challenges in Estimating the Impact of a Large-Scale Organizational Transformation

Quality Management in Health Care-October/December 2008
Vol. 17, No. 4
October/December 2008
Grembowski, D., Anderson, M.L., Conrad, D.A., Fishman, P.A., Larson, E.B., Martin, D.P., Ralston, J.D., Carrell, D., and J. Hecht
pp. 292-303

The Institute of Medicine argues that poorly designed delivery systems are a major cause of low-quality care in the United States but does not present methods for evaluating whether its recommendations, when implemented by a health care organization, actually improve quality of care.

A First Look at the New Medicare Prescription Drug Plans

Health Affairs - July/August 2006
Vol. 25, No. 4
July/August 2006
Frakt, A.B. and S.D. Pizer
pp. W252-61

Medicare began offering an outpatient prescription drug benefit through private plans in January 2006. Using nationwide data, we examine the availability, costs, and benefits of regional and local plans offering these benefits to beneficiaries. Because they are an entirely new concept for Medicare, we focus on stand-alone prescription drug plans, comparing them with other Medicare health plans offering drug coverage. The infamous "doughnut hole" exists for all but a few of these plans.

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