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Journal articles on the topic 'Managed health care model'

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Published: 4 June 2021

Last updated: 13 February 2022

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1

Cheng, Shou-Hsia, Chih-Ming Chang, Chi-Chen Chen, Chih-Yuan Shih, and Shu-Ling Tsai. "Half-Managed Care." International Journal of Health Services 47, no. 3 (November 19, 2015): 519–31. http://dx.doi.org/10.1177/0020731415615310.

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In 2011, a novel capitation program was launched in Taiwan under its universal health insurance plan. This study aimed to assess the short-term impact of the program. Two hospitals in the greater Taipei area, one participating in the “loyal patient” model (13,319 enrollees) and one in the “regional resident” model (13,768 enrollees), were analyzed. Two comparison groups were selected by propensity score matching. Generalized estimating equation models with differences-in-differences analysis were used to examine the net effects of the capitation program on health care utilization, expenses, and outcomes. Enrollees in the loyal patient model had fewer physician visits in the host hospital, but more physician visits outside that hospital during the program year than they had the year before. Compared with non-enrollees, the loyal patient model enrollees incurred fewer physician visits (β = −0.042, p < .001), fewer emergency department visits, (β = −0.140, p < .001), and similar total expenses and outcome. For the regional resident model, no differences were found in the number of physician visits, expenses, or outcomes between enrollees and non-enrollees. The novel capitation models in Taiwan had minimal impact on health care utilization after 1 year of implementation and the health care outcome was not compromised.

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2

Neufeld, Jonathan D., Robert E. Hales, Edward J. Callahan, and Thomas F. Anders. "Managed Care: The Behavioral Health Center: A Model for Academic Managed Care." Psychiatric Services 51, no. 7 (July 2000): 861–64. http://dx.doi.org/10.1176/appi.ps.51.7.861.

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3

Trombetta, William. "Managed care Medicaid." International Journal of Pharmaceutical and Healthcare Marketing 11, no. 2 (June 5, 2017): 198–210. http://dx.doi.org/10.1108/ijphm-09-2016-0049.

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Purpose Providing health care to the poor is evolving in the new US marketplace. The Affordable Care Act has set goals enhancing access to health care, lowering costs and improving patient outcomes. A key segment in this evolution is the most vulnerable health-care population of all: Medicaid. This paper aims to provide a general review of how providing health care to Medicaid patients is changing including how socio-economic aspects of this vulnerable population affects the quality of the health care provided. Design/methodology/approach The paper is entirely secondary research; no primary research has been conducted. Findings Managed care Medicaid provides a risk-based model to treating a vulnerable health-care market segment. The jury is still out on whether managed care Medicaid (MCM) is improving health-care quality and saving cost, but the provision of health care to the Medicaid segment is definitely shifting from a fee-for-service model to value based payment. Very recent developments of new health-care delivery approaches present a positive outlook for improving quality and containing costs going forward. Research limitations/implications At this stage, whether or not MCM saves money or provides better health-care quality to this vulnerable population is a work in progress. Health-care marketing can impact socio-economic aspects of health care for the poor. There is a need to follow up on the positive results being documented in demonstration health-care delivery models. Practical implications At this point, there has been no long-term study of whether managed care Medicaid offers better quality of health care and cost savings. The research to date suggest that the quality of health-care delivery to the poor is improving at a lower cost to payers. Social implications Medicaid patients are an underserved market segment. Managed care Medicaid offers a new model that has the potential to provide quality care at acceptable cost. Critical to this vulnerable market segment is the need to integrate socio-economic aspects of the population with the delivery of health care. Originality/value There has been very little discussion of Medicaid overall in the marketing literature, much less any discussion of managed care Medicaid.

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4

Weil, Thomas P. "Managed Care Merged with the German Model." American Journal of Medical Quality 12, no. 1 (March 1997): 19–24. http://dx.doi.org/10.1177/0885713x9701200104.

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5

Weil, Thomas P. "Merging managed care with the German model." International Journal of Health Planning and Management 12, no. 2 (April 1997): 115–30. http://dx.doi.org/10.1002/(sici)1099-1751(199704)12:2<115::aid-hpm462>3.0.co;2-w.

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6

Henley, A. J., and Maurice C. Clifford. "Managed Health Care for Medicaid Enrollees: The Philadelphia Model." Journal of Health Care for the Poor and Underserved 4, no. 3 (1993): 210–18. http://dx.doi.org/10.1353/hpu.2010.0212.

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7

Carter, Jean A. "Adjustment Disorders: A Managed Care Model of Mental Health." Contemporary Psychology: A Journal of Reviews 42, no. 12 (December 1997): 1101–2. http://dx.doi.org/10.1037/000653.

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8

Herron, William G., and Lydia K. Adlerstein. "The Dynamics of Managed Mental Health Care." Psychological Reports 75, no. 2 (October 1994): 723–41. http://dx.doi.org/10.2466/pr0.1994.75.2.723.

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Presented here is an exploration of the motivations involved in the development and application of managed mental health care to the private practice of outpatient psychotherapy. The interaction of management policy and psychotherapy is conceptualized in a dynamic model designed to provide insights into effective care policies. The model is described first, then the development of managed care, which appears defensive and is becoming symptomatic to the point of needing significant change. It is suggested that management policies providing choices of therapists and therapies will be the most effective in addressing ethical, fiscal, and psychological concerns of funders, consumers, and providers.

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9

Horn, Susan D., Phoebe D. Sharkey, and Richard Levy. "A Managed Care Pharmacoeconomic Research Model Based on the Managed Care Outcomes Project." Journal of Pharmacy Practice 8, no. 4 (August 1995): 172–77. http://dx.doi.org/10.1177/089719009500800405.

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Many American health care facilities have come to understand that quality controls cost. Clinical practice improvement (CPI) is a methodology that creates a clinical laboratory, built into the everyday practice setting, to find and test the best practices. A CPI study is an analysis of the content and timing of the individual steps of a medical care process to produce better clinical outcomes for the least necessary cost over the continuum of a patient's care. Statistical analyses are used to determine whether and how much a particular step actually improves medical outcomes. Systematic determination of individual medical process steps that improve medical outcomes is the best way to develop demonstrably better care and practice. Combining CPI methodology and a clinical quality monitor creates a dynamic environment in which all patient encounters potentially contribute to improving the process of care. We describe a recent multisite study: the Managed Care Outcomes Project (MCOP). The MCOP study design permits us to compare the effects of various pharmaceutical treatments on resource utilization in actual practice in managed care organizations. The MCOP database is an important resource for developing information required to design systems-based disease management programs. Copyright © 1995 by W.B. Saunders Company

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10

Browngoehl, K., K. Kennedy, K. Krotki, and H. Mainzer. "Increasing Immunization: A Medicaid Managed Care Model." PEDIATRICS 99, no. 1 (January 1, 1997): e4-e4. http://dx.doi.org/10.1542/peds.99.1.e4.

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11

Cerra, Frank B., Edward L. Kaplan, Sarah Jane Schwarzenberg, Ron Soltis, and Leo Twiggs. "A Managed Care Model for Home Infusion Therapy." American Journal of Medical Quality 10, no. 2 (June 1995): 93–99. http://dx.doi.org/10.1177/0885713x9501000206.

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12

Borkowski, Veronica. "Implementation of a Managed Care Model in an Acute Care Setting." Journal For Healthcare Quality 16, no. 2 (March 1994): 25–27. http://dx.doi.org/10.1111/j.1945-1474.1994.tb00695.x.

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13

Stern, Craig. "The Future of Health Care: Managed Care to Population Health." Journal of Contemporary Pharmacy Practice 64, no. 2 (June 1, 2017): 18–23. http://dx.doi.org/10.37901/jcphp16-00003.

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Federal and state regulations have driven change in health care from the volume of care delivered to the value of care provided. Yet, regulations are only part of the story. Major technology, commercial, and social drivers are making changes in health care that place the patient at the center and reorganize the communication and information avenues to change the dynamic of care itself and how it is delivered. As a result, the original intent of managed care to place the patient at the center of a market-based delivery system is being realized. When managed care was conceived, health care was delivered by silos that practiced in general vacuums leading to coordination of care inconsistencies and producing problems with handoffs between sites of care. The patient experience was variable and provided the majority of provider complaints. Outcomes of care were, and are, a priority but difficult to achieve without coordinated communication. Medicare and the Affordable Care Act (ACA) required a change but could not direct patient-centered outcomes without independent forces driving patient-centered care, communication between patients and all providers, and data repositories feeding analytics to identify actionable approaches to improving care. Managed care evolved with a focus on shifting care to the ambulatory sector. As a result, medication therapy became the primary cost-effective choice for care. Cost was a major consideration within the pharmacy benefit, because benefit models did not reduce physician and acute care hospital reimbursement to pay for ambulatory treatment. However, with the introduction of biotechnology methods to produce new and improved diagnostics, as well as treatments for previously untreatable or poorly treated illness, the boundary between site of care and expert providers blurred. The cost of production of these biotechnology “specialty” medications now requires that the entire expense of care is considered, and the division of benefits into medical and pharmacy is not an acceptable method for judging payment. This paper will attempt to discuss the future of health care, from general principles to how the changes will impact all providers. This is not forecasting using crystal ball gazing but rather predictions that are based on forces that already exist in the marketplace today.

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14

Zachary, Rebecca. "Formulary Management from a Health Maintenance Organization (HMO) Perspective." Journal of Pharmacy Practice 7, no. 2 (April 1994): 68–73. http://dx.doi.org/10.1177/089719009400700204.

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With the rise of managed care, formularies are being increasingly employed in the outpatient setting to manage use and control costs of prescription drugs. The formulary management policies of various managed care organizations are widely diverse and are largely dependent on the organizational structure of the managed care program. Although reasons for choosing certain types of formulary systems will be briefly explored, this article primarily focuses on formulary management tools used in the group model HMO setting. Various aspects of the formulary process that require ongoing management are described, including non-formulary drug usage, drug restrictions, drug use review, adverse drug reaction reporting, education of the professional staff, reporting of drug use data to physicians, and visitation by pharmaceutical sales representatives.

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15

Gomez, Madeleine Y., and Mitch Hall. "Reforming Managed Care Certification of Mental Health Services." Care Management Journals 6, no. 2 (June 2005): 73–79. http://dx.doi.org/10.1891/cmaj.6.2.73.

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This article examines the issues associated with the current managed care delivery system for certification of mental health services, including pain management. Inconsistencies in dispositions having impacts upon patient care appear to be inherent in the current peer review certification system. Issues related to public assistance clients will be given particular attention. After introducing the issues, this article reviews the literature to survey what facets have been the subjects of academic research and reflection. It then presents case examples of inconsistencies, followed by recommendations for a model with checks and balances. In conclusion, creation of an independent monitor group is recommended.

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16

Shuman, C. Ross. "Managed Psychiatric Care: A Suburban Medical Department Activity Model." Military Medicine 161, no. 9 (September 1, 1996): 557–61. http://dx.doi.org/10.1093/milmed/161.9.557.

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17

Reidy, William J. "Staff model HMO's and managed mental health care: One plan's experience." Psychiatric Quarterly 64, no. 1 (March 1993): 33–44. http://dx.doi.org/10.1007/bf01071837.

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18

Applebaum, Robert A., and Jennifer Heston. "INTEGRATING ACUTE AND LONG-TERM SERVICES: DOES IT WORK, CAN IT WORK, WILL IT WORK?" Innovation in Aging 3, Supplement_1 (November 2019): S229—S230. http://dx.doi.org/10.1093/geroni/igz038.848.

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Abstract The expansion of managed long-term services and supports has generated considerable interest over the last decade. However, studies on the impact of these efforts have produced mixed findings. Additionally, there is limited information about the care management models used in implementation. This lack of data makes it impossible to assess whether differences in managed care plan approaches have an impact on participants. Our study sought to gain better understanding of the integrated care management models being implemented in Ohio’s MyCare Demonstration. Through qualitative interviews with 50 respondents, including area agency care managers, managed care staff, and service providers, we documented strengths and weaknesses of one integrated care management model used in Ohio’s demonstration. Understanding what is inside the black box of managed care/care management model implementation is key to gaining insights into whether such an approach can ultimately improve the health and long-term service systems for older people with disability.

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Randall, Glen E. "Competition, Organizational Change, and Conflict: The Changing Role of Case Managers in Ontario’s Homecare System." Care Management Journals 8, no. 1 (March 2007): 2–7. http://dx.doi.org/10.1891/152109807780494096.

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As health care costs climb, governments continue to seek ways of controlling expenditures and improving accountability. One approach recently used by the government of Ontario to reform the delivery of homecare services focused on the introduction of competitive market forces in conjunction with the establishment of greater managerial controls over the activities of frontline health professionals. The purpose of this article is to assess how this “managed competition” model impacted the role of homecare case managers and their relationships with frontline health professionals. Data for this case study were obtained primarily through 36 in-depth key informant interviews with representatives from homecare provider agencies and the community care access centers (CCACs), which contract with the provider agencies for client services. The managed competition reform dramatically altered the role of homecare case managers by requiring them to take on greater responsibility for monitoring budgets and rationing services. This shift from a collaborative to a competitive system promoted conflict between case managers and other health care professionals. In the presence of an increasingly bureaucratized case manager role, interprofessional conflict and a focus on cost containment seems to have left clients without any clear advocate of their interests.

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20

Kastner, Theodore A., and Kevin K. Walsh. "Medicaid Managed Care Model of Primary Care and Health Care Management for Individuals With Developmental Disabilities." Mental Retardation 44, no. 1 (February 2006): 41–55. http://dx.doi.org/10.1352/0047-6765(2006)44[41:mmcmop]2.0.co;2.

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21

Bruce, Martha L., and Jo Anne Sirey. "Integrated Care for Depression in Older Primary Care Patients." Canadian Journal of Psychiatry 63, no. 7 (March 1, 2018): 439–46. http://dx.doi.org/10.1177/0706743718760292.

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For decades, depression in older adults was overlooked and not treated. Most treatment was by primary care providers and typically poorly managed. Recent interventions that integrate mental health services into primary care have increased the number of patients who are treated for depression and the quality of that treatment. The most effective models involve systematic depression screening and monitoring, multidisciplinary teams that include primary care providers and mental health specialists, a depression care manager to work directly with patients over time and the use of guideline-based depression treatment. The article reviews the challenges and opportunities for providing high-quality depression treatment in primary care; describes the 3 major integrated care interventions, PRISM-E, IMPACT, and PROSPECT; reviews the evidence of their effectiveness, and adaptations of the model for other conditions and settings; and explores strategies to increase their scalability into real world practice.

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22

Tolmac, Jovanka, Alun Lewis, Azer Mohammed, Elizabeth Fellow-Smith, Johan Redelinghuys, and Braulio Girelas. "North West London New Model of Care Project (NMOC) – improving inpatient mental health care for children and young people." BJPsych Open 7, S1 (June 2021): S199. http://dx.doi.org/10.1192/bjo.2021.535.

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AimsSpecialised inpatient mental health services for children and young people are commissioned and managed by NHS England (NHSE) and provided by NHS as well as independent sector. The access to beds has been managed nationally with young people admitted far from home. There were capacity issues identified in London. To address these concerns, NHSE invited organisations to work in partnership to co-design and establish new models of care. This is one of the first of such projects, set up to manage the budget for children and young people's beds on behalf of NHSE and change the way of managing and monitoring admissions.Our aims:To reduce length of inpatient stayTo enable admission of young people as close to home as possibleTo improve resource efficiency, capacity and capability of managing young people in crisis in the community.MethodA number of changes were introduced, including engagement of community and inpatient clinical staff, repatriation to units closer to home and introduction of CRAFT meetings (early review meetings in inpatient units to enable timely and effective discharge planning and support back to local services). The implementation has been closely monitored by the project manager and clinical group, which included representatives from all organisations involved.ResultAfter four years, young people are admitted to hospitals closer to home and the length of inpatient stay has decreased by 18%. The number of admissions has decreased by 28%. Out of area occupied beds days have been decreased by 66%.Significant recurrent budget savings have been achieved. Over the past three years, these savings have been reinvested in developing crisis community support and more specialist community services within CNWL and West London Trust.ConclusionThere have been considerable benefits of multiple organisations working in partnership to improve patients care. The success of the project has created further opportunities for the development of services which provide safe and effective alternatives to admission (such as crisis services, home treatment teams and specialized community services). In summary, this collaborative model has improved the quality of care and experience for young people and reduced the need for psychiatric admission.

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McDonald, R. C. "The Evolving Care of Diabetes: Models, managed care, and public health." Diabetes Care 20, no. 5 (May 1, 1997): 685–86. http://dx.doi.org/10.2337/diacare.20.5.685.

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24

Pomerantz, Jay M., Alfred H. Carter, Michael S. Perlman, and Benjamin Liptzin. "The Professional Affiliation Group: A New Model for Managed Mental Health Care." Psychiatric Services 45, no. 4 (April 1994): 308–10. http://dx.doi.org/10.1176/ps.45.4.308.

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25

Miller, Bess, Sara Rosenbaum, Paul V. Stange, Steven L. Solomon, and Kenneth G. Castro. "Tuberculosis Control in a Changing Health Care System: Model Contract Specifications for Managed Care Organizations." Clinical Infectious Diseases 27, no. 4 (October 1998): 677–86. http://dx.doi.org/10.1086/514962.

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26

Chapin, Christy Ford. "The American Medical Association, Health Insurance Association of America, and Creation of the Corporate Health Care System." Studies in American Political Development 24, no. 2 (August 23, 2010): 143–67. http://dx.doi.org/10.1017/s0898588x10000052.

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This narrative demonstrates how public and private power interacted during the post–World War II era to create America's unique health care system, a system based on a high-cost, corporate model financed and managed by insurance companies. The article compares the divergent political, organizational, and economic strategies of the American Medical Association (AMA), which represented physicians, and the Health Insurance Association of America (HIAA), which represented for-profit insurance firms. Even after the defeat of President Harry Truman's plan for a universal, government-managed system, policymakers in both parties attempted to reform the health care market, because most observers recognized that the embryonic insurance-company-funded model had inherent cost problems. In order to defeat numerous reform proposals, AMA and HIAA leaders allied to rapidly develop the market around insurance-company financing. Insurers and physicians constructed overlapping institutions to manage their increasingly close financial relationship, thus creating a pseudocorporate arrangement. In an attempt to control costs, insurance companies expanded their function beyond simply underwriting the risks associated with medical services consumption to also assuming a supervisory role, albeit distant, over health care delivery. When policymakers designed Medicare, they adopted the organizational framework that private health interests had already created, thereby legitimizing the previously contested high-cost model.

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27

Fisher, Brent A. "The Emergency Department and Managed Care: A Synergistic Model." Journal of Healthcare Management 43, no. 4 (July 1998): 339–57. http://dx.doi.org/10.1097/00115514-199807000-00009.

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28

Hurley, Robert E. "Promise and Performance in Managed Care: The Prepaid Group Practice Model." Journal of Health Politics, Policy and Law 20, no. 4 (1995): 1061–64. http://dx.doi.org/10.1215/03616878-20-4-1061.

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Brewer, Mrs Wendy. "Promise and performance in managed care. The prepaid group practive model." Health Policy 33, no. 1 (July 1995): 67–68. http://dx.doi.org/10.1016/0168-8510(95)90053-5.

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30

Morris, Philip. "Managed Care—A Personal View." Australasian Psychiatry 5, no. 3 (June 1997): 127–28. http://dx.doi.org/10.3109/10398569709082110.

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In the last few months our College has begun a serious debate about funding methods for psychiatric services. One of the funding models being considered is that of ‘managed care’. I practised in the United States from 1987 to late 1992 at a time when US style managed care reached its apogee as a form of financing for medical care, including psychiatric services. With this experience I am in a position to make some observations about the nature of managed care and the likely implications if it is introduced into Australian psychiatric practice.

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Meaney, Mark E. "A Deliberative Model of Corporate Medical Management." Journal of Law, Medicine & Ethics 28, no. 2 (2000): 125–36. http://dx.doi.org/10.1111/j.1748-720x.2000.tb00002.x.

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Managed care is evolving in ways that pose unique ethical challenges to those interested in the intersection of clinical and organizational ethics. For example, Disease Management (DM) is a form of managed care that has emerged in response to chronic illness. DM is a healthcare management tool that coordinates resources across an entire health care delivery system and throughout the life cycle of chronic disease. Health Maintenance Organizations have reduced some costs in the delivery of acute care, but real cost savings will result only with greater efficiencies in the delivery of costly chronic care. DM is a systematic, population-based approach that identifies persons at risk of chronic ailment, intervenes with specific programs of care, measures clinical and other outcomes, and provides continuous quality improvement. Characterized as a movement to patient-driven services, DM involves a complex web of provider relations.

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Shi, Peng, and Wei Zhang. "Managed Care and Health Care Utilization: Specification of Bivariate Models Using Copulas." North American Actuarial Journal 17, no. 4 (October 2, 2013): 306–24. http://dx.doi.org/10.1080/10920277.2013.849192.

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Khayal, Inas S., and Amro M. Farid. "Architecting a System Model for Personalized Healthcare Delivery and Managed Individual Health Outcomes." Complexity 2018 (2018): 1–24. http://dx.doi.org/10.1155/2018/8457231.

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In recent years, healthcare needs have shifted from treating acute conditions to meeting an unprecedented chronic disease burden. The healthcare delivery system has structurally evolved to address two primary features of acute care: the relatively short time period, on the order of a patient encounter, and the siloed focus on organs or organ systems, thereby operationally fragmenting and providing care by organ specialty. Much more so than acute conditions, chronic disease involves multiple health factors with complex interactions between them over a prolonged period of time necessitating a healthcare delivery model that is personalized to achieve individual health outcomes. Using the current acute-based healthcare delivery system to address and provide care to patients with chronic disease has led to significant complexity in the healthcare delivery system. This presents a formidable systems’ challenge where the state of the healthcare delivery system must be coordinated over many years or decades with the health state of each individual that seeks care for their chronic conditions. This paper architects a system model for personalized healthcare delivery and managed individual health outcomes. To ground the discussion, the work builds upon recent structural analysis of mass-customized production systems as an analogous system and then highlights the stochastic evolution of an individual’s health state as a key distinguishing feature.

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Fagan, Peter J., Chester W. Schmidt, and Barbara Cook. "A Model for Managed Behavioral Health Care in an Academic Department of Psychiatry." Psychiatric Services 53, no. 4 (April 2002): 431–36. http://dx.doi.org/10.1176/appi.ps.53.4.431.

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Calabrese, David. "Successful CQI-Based Programs In a Group-Model Managed Care Setting." Journal of Managed Care Pharmacy 1, no. 2 (September 1995): 134–37. http://dx.doi.org/10.18553/jmcp.1995.1.2.134.

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36

Kuziemko, Ilyana, Katherine Meckel, and Maya Rossin-Slater. "Does Managed Care Widen Infant Health Disparities? Evidence from Texas Medicaid." American Economic Journal: Economic Policy 10, no. 3 (August 1, 2018): 255–83. http://dx.doi.org/10.1257/pol.20150262.

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Medicaid programs increasingly finance competing, capitated managed care plans rather than administering fee-for-service (FFS) programs. We study how the transition from FFS to managed care affects high- and low-cost infants (blacks and Hispanics, respectively). We find that black-Hispanic disparities widen—e.g., black mortality and preterm birth rates increase by 15 percent and 7 percent, respectively, while Hispanic mortality and preterm birth rates decrease by 22 percent and 7 percent, respectively. Our results are consistent with a risk-selection model whereby capitation incentivizes competing plans to offer better (worse) care to low- (high-) cost clients to retain (avoid) them in the future. (JEL H75, I12, I18, I38, J13, J15)

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Markenson, D., and M. Reilly. "(A112) Development of Model Medical Care Protocols for Alternate Care Sites during Pandemics and Public Health Emergencies." Prehospital and Disaster Medicine 26, S1 (May 2011): s31—s32. http://dx.doi.org/10.1017/s1049023x11001142.

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IntroductionDeveloping alternative systems to deliver emergency health services during a pandemic or public health emergency is essential to preserving the operation of acute care hospitals and the overall health care infrastructure. Alternate care sites which can serve as areas for primary screening and triage or short-term medical treatment, can assist in diverting non-acute patients from hospital emergency departments and manage non-life threatening illnesses in a systematic and efficient manner. Maintaining consistent standards of care in these settings is essential to a uniform approach to the medical management of a public health emergency.MethodsSubject matter experts in emergency and disaster medicine, public health, pediatrics, and various other medical specialties were convened at regular intervals over an 18-month period. Through a consensus-based process this working group created a universal standard of care along with model clinical protocols to manage patients in an out-of-hospital setting using medical and non-medical personnel.ResultsThese protocols were designed to allow the mild to moderately ill patient to be managed in a non-acute care hospital or community-based care setting for a limited period of time and then return to their homes for convalescence. Of particular importance are that these protocols applicable to all public health emergencies and do not rely on the active presence of physicians at the alternate care site to render care.ConclusionThe development of consistent standards of care and the ability to care for patients in an out-of-hospital setting during a pandemic or public health emergency is essential to preserve the sustained operation of acute care hospitals and the entire healthcare system. Diverting patients to a community- based alternate care site or encouraging the early discharge of patients to these locations can assist in managing the large numbers of casualties anticipated during a pandemic or public health crisis.

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Aforismo, John F., Alan F. Kaul, Paul A. Tomondy, Gregory E. Parry, Lawrence B. Staubach, Gino Regalli, and Alan P. Dine. "Fluoroquinolone use for acute cystitis in an IPA-model managed care organization." American Journal of Health-System Pharmacy 52, no. 23 (December 1, 1995): 2702–4. http://dx.doi.org/10.1093/ajhp/52.23.2702.

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Kelleher, William J., G. Wayne Talcott, C. Keith Haddock, and R. Kelley Freeman. "Military psychology in the age of managed care: The Wilford Hall model." Applied and Preventive Psychology 5, no. 2 (March 1996): 101–10. http://dx.doi.org/10.1016/s0962-1849(96)80003-5.

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40

Sheetz, Anne H. "Developing School Health Services In Massachusetts: A Public Health Model." Journal of School Nursing 19, no. 4 (August 2003): 204–11. http://dx.doi.org/10.1177/10598405030190040401.

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In 1993 the Massachusetts Department of Public Health (MDPH) began defining essential components of school health service programs, consistent with the public health model. The MDPH designed and funded the Enhanced School Health Service Programs to develop 4 core components of local school health services: (a) strengthening the administrative infrastructure; (b) promoting health education, including tobacco control activities; (c) linking school health services with health care providers; and (d) implementing management information systems. Funds were appropriated in 1992 from the tobacco excise tax. With additional funding appropriated in 1999 and 2000 from the Tobacco Settlement Fund, these school nurse–managed programs have increased in number. The goal is to develop a statewide system of high-quality school health service programs responsive to the specific needs of students in each community. To be effective, these programs must be recognized as essential components of the primary health care delivery system serving children.

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Casciano, J., S. Arikian, JJ Doyle, and R. Casciano. "PHH9: A MANAGED CARE VALIDATION PROGRAM FOR A PHARMACOECONOMIC MODEL OF MAJOR DEPRESSION." Value in Health 3, no. 2 (March 2000): 80. http://dx.doi.org/10.1016/s1098-3015(11)70400-4.

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Steinman, T. I. "Managed care, capitation, and the future of nephrology." Journal of the American Society of Nephrology 8, no. 10 (October 1997): 1618–23. http://dx.doi.org/10.1681/asn.v8101618.

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Within the next decade, it is predicted that more than 90% of the United States population will receive its health insurance through managed care. Capitation will be the reimbursement mechanism to health care providers as the major way of controlling costs. Currently, managed care has had little experience with capitation payments for chronically ill patients, who consume large financial and physical resources. The end-stage renal disease (ESRD) population represents a vulnerable group of patients, and their care may be compromised in a capitated environment. Nephrologists will need to serve as advocates for ESRD patients through a mechanism of quality of care, driven by a continuous quality improvement model. Cost-effective delivery of care will occur as nephrologists join together to form Independent Practice Associations (IPAs). In this article, the role of a nephrologist in a capitated environment is outlined in detail, and background for the basis of managed care growth is provided as a framework for understanding the change in our health care delivery system. After formation of a nephrology IPA, there will most likely be a linkage with a management service organization (MSO). A business plan driven by the highest principles will allow nephrologists to work together as a cohesive force in accepting global risk capitated contracts. The starting point is for ESRD care, and the future includes pre-ESRD care.

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Sheets, Lincoln, Gregory Petroski, Yan Zhuang, Michael Phinney, Bin Ge, Jerry Parker, and Chi-Ren Shyu. "Combining Contrast Mining with Logistic Regression To Predict Healthcare Utilization in a Managed Care Population." Applied Clinical Informatics 08, no. 02 (April 2017): 430–46. http://dx.doi.org/10.4338/aci-2016-05-ra-0078.

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SummaryBackground: Because 5% of patients incur 50% of healthcare expenses, population health managers need to be able to focus preventive and longitudinal care on those patients who are at highest risk of increased utilization. Predictive analytics can be used to identify these patients and to better manage their care. Data mining permits the development of models that surpass the size restrictions of traditional statistical methods and take advantage of the rich data available in the electronic health record (EHR), without limiting predictions to specific chronic conditions.Objective: The objective was to demonstrate the usefulness of unrestricted EHR data for predictive analytics in managed healthcare.Methods: In a population of 9,568 Medicare and Medicaid beneficiaries, patients in the highest 5% of charges were compared to equal numbers of patients with the lowest charges. Contrast mining was used to discover the combinations of clinical attributes frequently associated with high utilization and infrequently associated with low utilization. The attributes found in these combinations were then tested by multiple logistic regression, and the discrimination of the model was evaluated by the c-statistic.Results: Of 19,014 potential EHR patient attributes, 67 were found in combinations frequently associated with high utilization, but not with low utilization (support>20%). Eleven of these attributes were significantly associated with high utilization (p<0.05). A prediction model composed of these eleven attributes had a discrimination of 84%.Conclusions: EHR mining reduced an unusably high number of patient attributes to a manageable set of potential healthcare utilization predictors, without conjecturing on which attributes would be useful. Treating these results as hypotheses to be tested by conventional methods yielded a highly accurate predictive model. This novel, two-step methodology can assist population health managers to focus preventive and longitudinal care on those patients who are at highest risk for increased utilization.Citation: Sheets L, Petroski GF, Zhuang Y, Phinney MA, Ge B, Parker JC, Shyu C-R. Combining contrast mining with logistic regression to predict healthcare Appl Clin Inform 2017; 8: 430–446 https://doi.org/10.4338/ACI-2016-05-RA-0078

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Okma, Kieke GH. "Will Dutch-style managed competition work in the Irish health system?" Volume 4 Issue 1 (2012) 4, no. 1 (January 1, 2012): 40. http://dx.doi.org/10.33178/ijpp.4.1.6.

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In early 2011 the new Irish government announced its intention to implement a model of "managed competition" inspired by the Dutch insurance reform of 2006 (Ryan and Mikkers 2011). This is to replace the central role of government in financing and providing health care services with a system of competing health insurers who are to contract health care services on behalf of their insured. The assumptions of "managed competition" (or “consumer-driven health care“) are fourfold: that health insurers are willing and able to selectively contract and pay hospitals and other health care providers; that providers are keen to offer better and cheaper care than their competitors; and that insured and patients will act as well-informed and critical consumers in selecting the insurance plan that best fits their needs; and that governments will (mostly) keep their hands off and let the market do the work in allocating scare health resources efficiently (see Enthoven and Van de Ven 2007; Bernstein 2011). Full Opinion piece pending final approval

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Harber, B. W., and SA Miller. "Program Management and Health Care Informatics: Defining Relationships." Healthcare Management Forum 7, no. 4 (December 1994): 28–35. http://dx.doi.org/10.1016/s0840-4704(10)61075-7.

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The program management (PM) structure is a relatively well-known organizational model for hospitals. A variation of the matrix structure, it allows for an interdisciplinary team of health care providers to facilitate patient care delivery. However, providing such focused care results in a complex, highly information-dependent operational environment. To meet the information needs of such an environment, careful planning in selecting and implementing technology is required. Along with supporting patient care, the technology will also help in managing costs, human resources, quality and utilization, as well as in monitoring performance and outcomes measurement. Focusing specifically on the information technology environment, this article addresses health care in formatics (the diverse categories of information and systems) needed to support clinical program managers, executives and others in a PM organization. Examples from both a university-affiliated and a community-based program managed hospital illustrate their approach to PM and information technology.

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Loughran, John, Tauqir Puthawala, Brad S. Sutton, Lorrel E. Brown, Peter J. Pronovost, and Andrew P. DeFilippis. "The Cardiovascular Intensive Care Unit—An Evolving Model for Health Care Delivery." Journal of Intensive Care Medicine 32, no. 2 (July 8, 2016): 116–23. http://dx.doi.org/10.1177/0885066615624664.

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Prior to the advent of the coronary care unit (CCU), patients having an acute myocardial infarction (AMI) were managed on the general medicine wards with reported mortality rates of greater than 30%. The first CCUs are believed to be responsible for reducing mortality attributed to AMI by as much as 40%. This drastic improvement can be attributed to both advances in medical technology and in the process of health care delivery. Evolving considerably since the 1960s, the CCU is now more appropriately labeled as a cardiac intensive care unit (CICU) and represents a comprehensive system designed for the care of patients with an array of advanced cardiovascular disease, an entity that reaches far beyond its early association with AMI. Grouping of patients by diagnosis to a common physical space, dedicated teams of health care providers, as well as the development and implementation of evidence-based treatment algorithms have resulted in the delivery of safer, more efficient care, and most importantly better patient outcomes. The CICU serves as a platform for an integrated, team-based patient care delivery system that addresses a broad spectrum of patient needs. Lessons learned from this model can be broadly applied to address the urgent need to improve outcomes and efficiency in a variety of health care settings.

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Scotton, Richard. "Managed competition:The policy context." Australian Health Review 22, no. 2 (1999): 103. http://dx.doi.org/10.1071/ah990103.

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In order to maintain universal access to medically effective care for all, costs must be contained at both the system-wide and micro levels. The managed competition model offers a framework within which increased efficiency could be pursued without sacrificing the goal of universal access and without impairing health outcomes and social cohesion. It would do this by removing structural impediments to rational decision-making and allocating to markets and governments the functions they perform best.

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Meador, Margaret George, and Laura A. Linnan. "Using the PRECEDE Model to Plan Men's Health Programs in a Managed Care Setting." Health Promotion Practice 7, no. 2 (April 2006): 186–96. http://dx.doi.org/10.1177/1524839904270502.

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Bachman, Sara S., Carol Tobias, Robert J. Master, Jeffrey Scavron, and Katherine Tierney. "A Managed Care Model for Latino Adults With Chronic Illness and Disability." Journal of Disability Policy Studies 18, no. 4 (March 2008): 197–204. http://dx.doi.org/10.1177/1044207307311304.

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Tisdale, Tina, and Aaron Liberman. "Managed Care—Present Day Challenges and A Working Model for Future Consideration." Health Care Manager 21, no. 2 (December 2002): 46–59. http://dx.doi.org/10.1097/00126450-200212000-00008.

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