Plans in Organizations

The contribution of health plans and provider organizations to variations in measured plan quality.

OBJECTIVE Some argue that health plans have minimal impacts on quality of care and that quality data collection should focus only on physician organizations. We investigate the relative impact of physician organizations and health plans on quality measures. DESIGN Statistical analysis of data on 9 Healthcare Effectiveness Data and Information Set (HEDIS) measures from 6 health plans and 159 p...

Medicare and Medicaid programs; requirements for physician incentive plans in prepaid health care organizations--HCFA. Final rule.

This final rule amends the regulations established by a March 27, 1996, final rule with comment period. The regulations govern physician incentive plans operated by Federally-qualified health maintenance organizations and competitive medical plans contracting with the Medicare program, and certain health maintenance organizations and health insuring organizations contracting with the Medicaid p...

Variation in Patient-Reported Quality Among Health Care Organizations

Health care quality measurement initiatives often use health plans as the unit of analysis, but plans often contract with provider organizations that are managed independently. There is interest in understanding whether there is substantial variability in quality among such units. We evaluated the extent to which scores on the Consumer Assessment of Health Plans Study (CAHPS) survey vary across...

Environment of care management plans. Making sure your plans get the job done.

Risk selection in the Massachusetts State employee health insurance program.

Using the Diagnostic Cost Group (DCG) model developed from a national sample, we examine biased selection among one fee-for-service (FFS) plan, one preferred provider organization, and several health maintenance organizations (HMOs) in Massachusetts. The proportions of enrollees in low-risk groups are higher in the HMO plans and lower in the FFS plan. The average age in the FFS plan is 9 years ...

Two Wrongs Do Not Make a Right: Flaws in Alternatives to Fee-for-Service Payment Plans Do Not Mean Fee-for-Service Is a Good Solution to Rising Prices; Comment on “Fee-for-Service Payment - An Evil Practice That Must Be Stamped Out?”

Professor Naoki Ikegami’s “Fee-for-service payment – an evil practice that must be stamped out” summarizes many of the failings of alternatives to fee-for-service (FFS) payment systems. His article also offers several suggestions for improving FFS systems. However, even powerful arguments against many of the alternatives to FFS, does not make a convincing argument for FFS systems. In addition, ...