Organizational and Financial Characteristics of Health Plans

Safran, Dana Gelb; Rogers, William H.; Tarlov, Alvin R.; Inui, Thomas S.; Taira, Deborah A.; Montgomery, Jana E.; Ware, John E.; Slavin, Charles P.

doi:10.1001/archinte.160.1.69

Cited by 65 publications

(56 citation statements)

References 20 publications

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“…Comparisons of health plans have not always adjusted for the socioeconomic or health status of individual members or data collection techniques between health plans (28,33). Other studies (31,34) examining the organizational model have been unable to include clinical measures of quality. Also, prior studies have focused on group/staff versus IPA models, with little information on group/network models.…”

Section: Discussionmentioning

confidence: 99%

Managed Care Organization and the Quality of Diabetes Care

Kim

Williamson²,

Mangione

et al. 2004

Diabetes Care

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OBJECTIVE -To examine the association between the organizational model and diabetes processes of care.RESEARCH DESIGN AND METHODS -We used data from the Translating Research into Action for Diabetes (TRIAD), a multicenter study of diabetes care in managed care, including 8,354 patients with diabetes. We identified five model types: for-profit group/network, for-profit independent practice association (IPA), nonprofit group/network, nonprofit IPA, and nonprofit group/staff. Process measures included retinal, renal, foot, lipid, and HbA 1c testing; aspirin recommendations; influenza vaccination; and a sum of these seven processes of care over 1 year. Hierarchical regression models were constructed for each process measure and accounted for clustering at the health plan and provider group levels and adjusted for participant age, sex, race, ethnicity, diabetes treatment and duration, education, income, health status, and survey language.RESULTS -Participant membership in the model types ranged from 9% in nonprofit IPA models to 38% in nonprofit group/staff models. Over 75% of participants received most of the processes of care, regardless of model type. However, among for-profit plans, group/network models provided on average more processes of care than IPA models (5.5 vs. 4.7, P Ͻ 0.0001), and group/network models generally increased the probability of receiving a process by Ն10 percentage points. Among nonprofit plans, no effect of model type was found.CONCLUSIONS -Among for-profit plans, group/network models provided better diabetes processes of care than IPA models. Although reasons are speculative, this may be due to the clinical infrastructure available in group models that is not available in IPA models.

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Section: Discussionmentioning

confidence: 99%

Managed Care Organization and the Quality of Diabetes Care

Kim

Williamson²,

Mangione

et al. 2004

Diabetes Care

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“…For example, formal educational programs for guidelines may be effective in containing costs, while use of a larger number of different guideline applications increased costs (Rich et al 1998). From the patient perspective, guidelines may also be negatively related to clinicianpatient communication, interpersonal treatment, and trust (Safran et al 2000). In addition, guidelines may become less popular from a provider perspective as physicians surveyed twice over a two-year period increasingly believed that guidelines were being used more for cost containment (71% vs. 92%) than quality improvement (85% vs. 67%) (Inouye et al 1998).…”

Section: Educational Interventionsmentioning

confidence: 99%

From Physician to Consumer: The Effectiveness of Strategies to Manage Health Care Utilization

2002

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Many strategies are commonly used to influence physician behavior in managed care organizations. This review examines the effectiveness of three mechanisms to influence physician behavior: financial incentives directed at providers or patients, policies/procedures for managing care, and the selection/education of both providers and patients. We reach three conclusions. First, all health care systems use financial incentives, but these mechanisms are shifting away from financial incentives directed at the physician to those directed at the consumer. Second, heavily procedural strategies such as utilization review and gatekeeping show some evidence of effectiveness but are highly unpopular due to their restrictions on physician and patient choice. Third, a future system built on consumer choice is contradicted by mechanisms that rely solely on narrow networks of providers or the education of physicians. If patients become the new locus of decision-making in health care, provider-focused mechanisms to influence physician behavior will not disappear but are likely to decline in importance.

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“…4,6,7 Trust is considered to be a vital element of the therapeutic alliance and may be closely related to the degree to which patients seek routine medical care, adhere to prescribed medications, and maintain long-term relationships with medical providers and health insurers. [8][9][10][11] Thus, findings regarding racial differences in trust may contribute insight into racial disparities in health and health care. 12 While many studies have focused on the patientphysician relationship and attitudes toward health care, [12][13][14] little work has been done to investigate racial differences in attitudes toward different components of health service delivery.…”

mentioning

confidence: 99%

Race and Trust in the Health Care System

Boulware

Cooper

Ratner

et al. 2003

Public Health Reports

582

489

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SYNOPSISObjective. A legacy of racial discrimination in medical research and the health care system has been linked to a low level of trust in medical research and medical care among African Americans. While racial differences in trust in physicians have been demonstrated, little is known about racial variation in trust of health insurance plans and hospitals. For the present study, the authors analyzed responses to a cross-sectional telephone survey to assess the independent relationship of self-reported race (non-Hispanic black or non-Hispanic white) with trust in physicians, hospitals, and health insurance plans.Methods. Respondents ages 18-75 years were asked to rate their level of trust in physicians, health insurance plans, and hospitals. Items from the Medical Mistrust Index were used to assess fear and suspicion of hospitals.Results. Responses were analyzed for 49 (42%) non-Hispanic black and 69 (58%) non-Hispanic white respondents (N=118; 94% of total survey population). A majority of respondents trusted physicians (71%) and hospitals (70%), but fewer trusted their health insurance plans (28%). After adjustment for potential confounders, non-Hispanic black respondents were less likely to trust their physicians than non-Hispanic white respondents (adjusted absolute difference 37%; p=0.01) and more likely to trust their health insurance plans (adjusted absolute difference 28%; p=0.04). The difference in trust of hospitals (adjusted absolute difference 13%) was not statistically significant. Non-Hispanic black respondents were more likely than non-Hispanic white respondents to be concerned about personal privacy and the potential for harmful experimentation in hospitals.Conclusions. Patterns of trust in components of our health care system differ by race. Differences in trust may reflect divergent cultural experiences of blacks and whites as well as differences in expectations for care. Improved understanding of these factors is needed if efforts to enhance patient access to and satisfaction with care are to be effective.

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Organizational and Financial Characteristics of Health Plans

Cited by 65 publications

References 20 publications

Managed Care Organization and the Quality of Diabetes Care

Managed Care Organization and the Quality of Diabetes Care

From Physician to Consumer: The Effectiveness of Strategies to Manage Health Care Utilization

Race and Trust in the Health Care System

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