Medicare Managed Care plan Performance: A Comparison across Hospitalization Types

Medicare and Medicaid Research Review

Volumn 2, Issue 1, 2012, Pages

  Basu, Jayasree ^a   Mobley, Lee Rivers ^b  

^a AGENCY FOR HEALTHCARE RESEARCH AND QUALITY   (United States)

^b RTI INTERNATIONAL   (United States)

Author keywords

Ambulatory care sensitive admissions; Elderly; Hospital admissions; Managed care; Medicare; Preventable hospitalizations; Primary care quality; Referral patterns; Referral sensitive admissions

Indexed keywords

ARTICLE; HEALTH CARE COST; HEALTH CARE PLANNING; HEALTH CARE QUALITY; HEALTH CARE UTILIZATION; HEALTH INSURANCE; HOSPITAL ADMISSION; HOSPITAL DISCHARGE; HOSPITALIZATION; MANAGED CARE; MEDICARE; PATIENT REFERRAL; RISK FACTOR; UNITED STATES; AGED; COMPARATIVE STUDY; CROSS-SECTIONAL STUDY; EPIDEMIOLOGY; FEMALE; HEALTH MAINTENANCE ORGANIZATION; HUMAN; MALE; ORGANIZATION AND MANAGEMENT; RISK; STANDARDS; STATISTICS AND NUMERICAL DATA; VERY ELDERLY;

AGED; AGED, 80 AND OVER; CALIFORNIA; CROSS-SECTIONAL STUDIES; FEMALE; FLORIDA; HEALTH MAINTENANCE ORGANIZATIONS; HOSPITALIZATION; HUMANS; MALE; MANAGED CARE PROGRAMS; MEDICARE; NEW YORK; REFERRAL AND CONSULTATION; RISK; UNITED STATES;

EID: 84930473933     PISSN: 21590354     EISSN: None     Source Type: Journal    
DOI: 10.5600/mmrr.002.01.a02     Document Type: Article

References (39)

1. Agency for Healthcare Research and Quality (AHRQ) (2004). Healthcare Cost and Utilization Project (HCUP). Rockville, MD. Accessed online December 2005: http://www.hcup-us.ahrq.gov/db/state/siddbdocumentation.jsp
2. Ansari, Z., Laditka, J. N., & Laditka, S. B. (2006). Access to Health care and Hospitalization for Ambulatory care Sensitive Conditions. Medical Care Research and Review, 63(6), 719-741. PubMed http://dx.doi.org/10.1177/1077558706293637
3. Backus, L., Moron, M., Bacchetti, P., Baker, L. C., & Bindman, A. B. (2002). Effect of managed care on preventable hospitalization rates in California. Medical Care, 40(4), 315-324. PubMed http://dx.doi.org/10.1097/00005650-200204000-00007
4. Basu, J., & Clancy, C. (2001). Racial Disparity, Primary Care, and Specialty Referral. Health Services Research, 36(6, pt. II), 64-77. PubMed
5. Basu, J., Friedman, B., & Burstin, H. (2002). Primary care, HMO enrollment, and hospitalization for ambulatory care sensitive conditions: a new approach. Medical Care, 40(12), 1260-1269. PubMed http://dx.doi.org/10.1097/00005650-200212000-00013
6. Basu, J., Friedman, B., & Burstin, H. (2004). Managed care and preventable hospitalization among Medicaid adults. Health Services Research, 39(3), 489-510. PubMed http://dx.doi.org/10.1111/j.1475-6773.2004.00241.x
7. Basu, J., & Mobley, L. R. (2007). Do HMOs reduce Preventable Hospitalizations for Medicare Beneficiaries? Medical Care Research and Review, 64(5), 544-567. PubMed http://dx.doi.org/10.1177/1077558707301955
8. Basu, J., & Mobley, L. (2008). Racial Disparities in the Elderly for Selected Procedures. Medical Care Research and Review, 65(5), 617-637. PubMed http://dx.doi.org/10.1177/1077558708318284
9. Billings, J., Zeitel, L., Lukomnik, J., Carey, T. S., Blank, A. E., & Newman, L. (1993). Impact of socioeconomic status on hospital use in New York City. Health Affairs (Project Hope), 12(1), 162-173. PubMed http://dx.doi.org/10.1377/hlthaff.12.1.162
10. Blustein, J., Hanson, K., & Shea, S. (1998). Preventable Hospitalizations and Socioeconomic Status. Health Affairs, 17(2), 177-189. PubMed http://dx.doi.org/10.1377/hlthaff.17.2.177
11. Call, K.T., Dowd, T., Feldman, B., & Maciejewski, R. (1999). Selection Experiences in Medicare HMOs: Pre-Enrollment Expenditures. Health Care Financing Review, 20(4), 197-209. PubMed
12. Coffey, R. M., & Goldfarb, M. G. (1986). DRGs and disease staging for reimbursing Medicare patients. Medical Care, 24(9), 814-829. PubMed http://dx.doi.org/10.1097/00005650-198609000-00003
13. Epstein, A. J. (2001). The role of public clinics in preventable hospitalizations among vulnerable populations. Health Services Research, 36(2), 405-420. PubMed
14. Folland, S. A., Goodman, A. C., & Stano, M. (1997). The Economics of Health Care. Second edition, Upper saddle river, NJ: Prentice Hall
15. Forrest, C. B., & Reid, R. J. (1997). Passing the Baton: HMO's influence on referrals to specialty care. Health Affairs, 16(6), 157-162. PubMed http://dx.doi.org/10.1377/hlthaff.16.6.157
16. Fournier, G. M. & McInnes, M. (2002). The Effects of Managed care on Medical Referrals and the Quality of Specialty care. The Journal of Industrial Economics, 50(4), 457-473. http://dx.doi.org/10.1111/1467-6451.00186
17. Franks, P. & Clancy, C. M. (1997). Referrals of Adult patients from Primary care: Demographic disparities and Their Relationship to HMO Insurance. The Journal of Family Practice, 45(1), 47-53. PubMed
18. Friedman, B. & Basu, J. (2001). Health insurance, primary care, and preventable hospitalization of children in a large state. The American Journal of Managed Care, 7(5), 473-481. PubMed
19. Gold, M., Achman, L., Mittler, J., & Stevens, B. (2004). Monitoring Medicare_Choice: What have we learned? Findings and operational lessons for Medicare Advantage. MPR publication no. 8846-200 done under contract no. 43005 for Robert Wood Johnson Foundation. Princeton, NJ: Mathematica Policy Research, Inc.
20. Goodman, D. C., Mick, S. S., Bott, D., Stukel, T., Chang, C., Marth, N.,. Carretta, H. J. (2003). Primary care service areas: a new tool for the evaluation of primary care services. Health Services Research, 38(1p1), 287-309. PubMed http://dx.doi.org/10.1111/1475-6773.00116
21. Government Accoutning Office (GAO) (2000). Medicare and Medicaid: Implementing state demonstrations for dual eligibles has proven challenging. Report to the U.S. Senate Special Committee on Aging. Washington, DC: U.S. General Accounting Office. http://www.gao.gov/new.items/he00094.pdf (accessed April 17, 2007).
22. Greene, W. H. (1993). Econometric analysis (2nd ed., pp. 666-672). New York: Macmillan.
23. Homer, C. J., Szilagyi, P., Rodewald, L., Bloom, S. R., Greenspan, P., Yazdgerdi, S.,. Perrin, J. M. (1996). Does Quality of Care Affect Rates of Hospitalization for Childhood Asthma? Pediatrics, 98(1), 18-23. PubMed
24. Krakauer, H., Jacoby, I., Millman, M., & Lukomnik, J. E. (1996). Physician Impact on Hospital Admission and on Mortality Rates in the Medicare Population. Health Services Research, 31(2), 191-211. PubMed
25. Kruzikas, D. T., Jiang, H. J., Remus, D., Barrett, M. L., Coffey, R. M., & Andrews, R. (2000). Preventable Hospitalizations: A Window Into Primary and Preventive Care, 2000. Healthcare Cost and Utilization Project (HCUP) Fact Book No. 5 (AHRQ Publication No. 04-0056). Agency for Healthcare Research and Quality (AHRQ), Rockville, MD.
26. Long, S. K., & Coughlin, T. A. (2001). Impacts of Medicaid managed care on children. Health Services Research, 36(1 Pt 1), 7-23. PubMed
27. Mello, M. M., Stearns, S. C., & Norton, E. C. (2002). Do Medicare HMOs still reduce health services use after controlling for selection bias? Health Economics, 11(4), 323-340. PubMed http://dx.doi.org/10.1002/hec.664
28. Mello, M. M., Stearns, S. C., Norton, E. C., & Ricketts, T. C., III. (2003). Understanding Biased Selection in Medicare HMOs. Health Services Research, 38(3), 961-992. PubMed http://dx.doi.org/10.1111/1475-6773.00156
29. Mobley, L. R., Root, E. D., Anselin, L., Garcia, N. L., & Koschinsky, J. (2006). Spatial Analysis of Elderly Access to Primary Care Services. International Journal of Health Geographics, 5. http://www.ij-healthgeographics.com/content/5/1/19 PubMed http://dx.doi.org/10.1186/1476-072X-5-19
30. National Health Policy Forum {pipe} www.nhpf.org, November 29, 2005
31. Parchman, M. L., & Culler, S. (1994). Primary Care Physicians and Avoidable Hospitalization. The Journal of Family Practice, 39(2), 123-128. PubMed
32. Pizer, S.D., Frakt, A.B., & Feldman, R. (2007) Regional PPOs in Medicare: what are the prospects? Academy Health, February 2007.
33. Pope, G., Olmsted, E. A., Kautter, J., Mobley, L. R., & Greenwald, L. M. (April 2005). The Medicare Preferred Provider Organization Demonstration: Plan Offerings and Enrollment. Final Report. Prepared for the Centers for Medicare & Medicaid Services (RTI Project Number 07964.005.007).
34. Pope, G.C., Greenwald, L. M., Kautter, J., Olmstead, E. A., & Mobley, L. R. (2006). Medicare Preferred Provider Organization Demonstration: Plan Offerings and Beneficiary Enrollment. Health Care Financing Review, 27(3), 95-109. PubMed
35. Schreiber, S., & Zielinsky, T. (1997). The Meaning of Ambulatory care Sensitive Admissions:urban and rural Perspectives. The Journal of Rural Health, 13(4), 276-284. PubMed http://dx.doi.org/10.1111/j.1748-0361.1997.tb00970.x
36. Schulz, A. J., Williams, D. R., Israel, B. A., & Lempert, L. B. (2002). Racial and spatial relations as fundamental determinants of health in Detroit. The Milbank Quarterly, 80(4), 677-707. PubMed http://dx.doi.org/10.1111/1468-0009.00028
37. STATA (Version 8.0) [Computer software]. College Station, TX: StataCorp
38. Terza, J. V., Basu, A., & Rathouz, P. J. (2008). Two-stage residual inclusion estimation: addressing endogeneity in health econometric modeling. Journal of Health Economics, 27(3), 531-543. Epub 2007 Dec 4 PubMed http://dx.doi.org/10.1016/j.jhealeco.2007.09.009
39. Weissman, J. S., Gatsonis, C., & Epstein, A. M. (1992). Rates of Avoidable Hospitalization by Insurance Status in Massachusetts and Maryland. Journal of the American Medical Association, 268(17), 2388-2394. PubMed http://dx.doi.org/10.1001/jama.1992.03490170060026