How do HMOs achieve savings? The effectiveness of one organization's strategies

Health Services Research

Volumn 33, Issue 1, 1998, Pages 79-99

  Flood, Ann Barry ^a   Fremont, Allen M ^a   Jin, Kinam ^a   Bott, David M ^a   Ding, Jiao ^a   Parker Jr , Robert C ^a  

^a NONE

Author keywords

Episodes of care; Financial incentives; Managed care HMO; Organizational strategies; Resource utilization

Indexed keywords

COST CONTROL; GENERAL PRACTITIONER; HEALTH MAINTENANCE ORGANIZATION; MEDICAL FEE; MEDICAL SPECIALIST; OUTPATIENT CARE; RESOURCE ALLOCATION; REVIEW;

ADULT; CHILD; COST SAVINGS; FEE-FOR-SERVICE PLANS; FEMALE; GROUP PRACTICE; HEALTH MAINTENANCE ORGANIZATIONS; HUMANS; ILLINOIS; MALE; MIDDLE AGED; ORGANIZATIONAL INNOVATION; PATIENT CARE TEAM; PHYSICIAN INCENTIVE PLANS; REIMBURSEMENT, INCENTIVE; UTILIZATION REVIEW;

EID: 0031955982     PISSN: 00179124     EISSN: None     Source Type: Journal    
DOI: None     Document Type: Review

References (28)

1. Bernstein, A. B., J. Bernstein. 1996. "HMOs and Health Services Research: The Penalty of Taking the Lead." Medical Care Research and Review 53 (Suppl.): S18-S43.
2. Bluestone, C. D., and J. O. Klein. 1988. Otitis Media in Infants and Children. Philadelphia, PA: W. B. Saunders & Co.
3. Clauser, S. B., C. M. Fanta, and A. J. Finel. 1984. Physicians' Current Procedural Terminology (CPT-4), 4th ed. Chicago: American Medical Association.
4. Davis, J. A. 1985. The Logic of Causal Order, Beverly Hills, CA: Sage Publications.
5. Dorsey, J. L. 1983. "Use of Diagnostic Resources in Health Maintenance Organizations and Fee-For-Service Settings." Archives of Internal Medicine 143 (10): 1863-65.
6. Emanuel, E., and N. Dubler. 1995. "Preserving the Physician-Patient Relationship in the Era of Managed Care." Journal of the American Medical Association 273 (25): 323-29.
7. Group Health Association of America. 1994. HMO Industry Profile, 1994 ed. Washington, DC: GHAA.
8. Gold, M. 1981. "Effects of Hospital-Based Primary Care Setting on Internists' Treatment of Primary Care Episodes." Health Services Research 16 (4): 383-405.
9. Gold, M., L. Nelson, T. Lake, R. Hurley, and R. Berenson. 1995. "Behind the Curve: A Critical Assessment of How Little Is Known About Arrangements Between Managed Care Plans Physicians." Medical Care Research Review 52 (3): 307-41.
10. Goodman, D. C., E. S. Fisher, T. A. Stukel, and C. Chang. 1997. "The Distance to Community Medical Care and the Likelihood of Hospitalization." American Journal of Public Health 87 (7); 1149-50.
11. Hellinger, F. J. 1996, "The Impact of Financial Incentives on Physician Behavior in Managed Care Plans." Medical Care Research and Review 53 (3): 294-314.
12. Hillman, A. L., M. V. Pauly, and J. J. Kerstein. 1989. "How Do Financial Incentives Affect Physicians' Clinical Decisions the Financial Performance of Health Maintenance Organizations?" The New England Journal of Medicine 320 (2): 86-92.
13. Hlatky, M. A., L. L. Kerry, E. H. Botvinick, and B. H. Brundage. 1983. "Diagnostic Test Use in Different Practice Setup: A Controlled Comparison." Archives of Internal Medicine 143 (10): 1886-89.
14. Hormbrook, M. C., A. V. Hortado, and R. E. Johnson. 1985. "Healthcare Episodes: Definition, Measurement, and Use." Medical Care Review 42 (2): 163-218.
15. International Classification of Diseases, 9th Revision: Clinical Modification (ICD-9-CM). 1992. Los Angeles, CA: Practice Management Information Corp.
16. Kralewski, J. E. 1996. "The Effects of Capitation Payment on the Organizational Structure of Medical Group Practice." Journal of Ambulatory Care Management 19 (1): 1-16.
17. Luft, H. S. 1978. "How Do Health Maintenance organizations Achieve Their "Savings'? Rhetoric and Evidence." The New England Journal of Medicine 298 (24): 1336-43.
18. _. 1981. Health Maintenance Organizations. New York: John Wiley.
19. Manning, W. G., A. Leibowitz, G. A. Goldberg, J. P. Newhouse. 1984. "A Controlled Trial of the Effect of a Prepaid Group Practice on Use of Services." The New England Journal of Medicine 310 (23): 1505-10.
20. Martin, D. P., P. Diehr, K. F. Price, and W. C. Richardson.1989. "Effect of a Gatekeeper Plan on Health Services Use and Charges: A Randomized Trial." American Journal of Public Health 79 (12): 1628-32.
21. Mechanic, D., and M. Schlesinger. 1996. "The Impact of Managed Care on Patients' Trust in Medical Care and Their Physicians." Journal of the American Medical Association 275 (21): 1693-97.
22. Miller, R. H., and H. S. Luft. 1994. "Managed Care Plan Performance Since 1980." Journal of the American Medical Association 271 (19): 1512-19.
23. Stearns, S., B. Wolfe, D. Kindig. 1992, "Physician Responses to Fee-For-Service and Capitation Payment." Inquiry 29 (4): 416-25.
24. Stolzenberg, R. M. 1980. "The Measurement and Decomposition of Causal Effects in Nonlinear Nonadditive Models." In Sociological Methodology, edited by K. F. Schuessler. San Francisco: Jossey-Bass.
25. Udvarhelyi, I. S., K. Jennison, R. S. Phillips, and A. M. Epstein. 1991 "Comparison of the Quality of Ambulatory Care for Fee-For-Service or Prepaid Patients." Annals of Internal Medicine 115 (5): 394-400.
26. Wingert, T. D., J. E. Kralewski, and T. J. Lindquist. 1995. "Constructing Episodes of Care from Encounter and Claims Data." Inquiry 32 (4): 430-43.
27. Wolinsky, F. D. 1980. "The Performance of Health Maintenance organizations: An Analytic Review." Milbank Memorial Fund Quarterly 58 (4): 537-37.
28. Yin, R. K. 1994. Case Study Research: Design and Methods, 2nd ed. Applied Social Science Research Methods Series, Vol. 5. Thousand Oaks, CA: Sage Publications.