OBJECTIVE To prospectively compare inpatient and outpatient utilization rates between prepaid (PPD) and fee-for-service (FFS) insurance coverage for patients with chronic disease. DATA SOURCE/STUDY SETTING Data from the Medical Outcomes Study, a longitudinal observational study of chronic disease patients conducted in Boston, Chicago, and Los Angeles. STUDY DESIGN A four-year prospective st...

BACKGROUND The purpose of this study is to analyze the relationship between newly introduced primary care models in Ontario, Canada, and patients' primary care and total health care costs. A specific focus is on the payment mechanisms for primary care physicians, i.e. fee-for-service (FFS), enhanced-FFS, and blended capitation, and whether providers practiced as part of a multidisciplinary team...

BACKGROUND To improve the financing of Colorado's public mental health system, the state designed, implemented, and evaluated a pilot program that consisted of three reimbursement models for the provision of outpatient services. Community mental health centers (CMHCs), the primary providers of comprehensive mental health services to Medicaid recipients in Colorado, had to search for innovative ...

OBJECTIVE Use of physician service claims and other administrative data is increasingly being advocated for chronic disease surveillance. However, such data may be vulnerable to reimbursement policy changes. We sought to determine how non-fee-for-service (non-FFS) primary care affects the detection of diabetes using physician claims data. METHODS Ontarians over age 66 with diabetes and receiv...

BACKGROUND Our aim was to compare access to effective care among elderly Medicare patients in a Staff Model and Group Model HMO and in Fee-for-Service (FFS) care. METHODS We used a retrospective cohort study design, using claims and automated medical record data to compare achievement on quality indicators for elderly Medicare recipients. Secondary data were collected from 1) HMO data sets an...

OBJECTIVES To compute a benchmark for tracking readmission rates among patients enrolled in Medicare's private comprehensive Medicare Advantage (MA) plans and to develop preliminary comparisons with the fee-for-service (FFS) readmission rates. STUDY DESIGN Descriptive data presentation with analytic discussion. METHODS We computed a benchmark for rehospitalization rates among MA patients us...

OBJECTIVE To compare the clinical quality of care between Medicare fee-for-service (FFS) and Medicare Advantage (MA) programs. METHODS We compared 11 Healthcare Effectiveness Data and Information Set (HEDIS) quality measures nationwide for MA managed care plans and the FFS program in 2006 and 2007. We adjusted FFS measures to match the geographic distribution of MA. RESULTS Medicare Advanta...

OBJECTIVES To assess differences in services associated with mental health status and prescriptions among Medicaid patients diagnosed with diabetes mellitus. DESIGN Secondary data analyses of South Carolina (SC) Medicaid enrollees. PARTICIPANTS SC Medicaid enrollees with a diagnosis of diabetes mellitus (N = 555) continuously enrolled in either managed care (MC) or fee for service (FFS) pro...

Fee-For-Service (FFS) contracts, first introduced in 2004, dramatically changed the way the pharmaceutical distribution supply chains are designed, managed, and operated. Investment buying (IB), forward buying in anticipation of drug price increases, used to be the way the distributors made most of their profits! FFS contracts limit the amount of inventory distributors can carry at any time (by...

PURPOSE As an alternative to the existing fee-for-service (FFS) system, a diagnosis-related group (DRG)-based payment system has been suggested. The aim of this study was to investigate the early results of pediatric appendicitis treatment under the DRG system, focusing on health care expenditure and quality of health care services. PATIENTS AND METHODS The medical records of 60 patients, 30 ...