Abstract：
OBJECTIVE:To compare the performance of various risk adjustment models in behavioral health applications such as setting mental health and substance abuse (MH/SA) capitation payments or overall capitation payments for populations including MH/SA users. DATA SOURCES/STUDY DESIGN:The 1991-93 administrative data from the Michigan Medicaid program were used. We compared mean absolute prediction error for several risk adjustment models and simulated the profits and losses that behavioral health care carve outs and integrated health plans would experience under risk adjustment if they enrolled beneficiaries with a history of MH/SA problems. Models included basic demographic adjustment, Adjusted Diagnostic Groups, Hierarchical Condition Categories, and specifications designed for behavioral health. PRINCIPAL FINDINGS:Differences in predictive ability among risk adjustment models were small and generally insignificant. Specifications based on relatively few MH/SA diagnostic categories did as well as or better than models controlling for additional variables such as medical diagnoses at predicting MH/SA expenditures among adults. Simulation analyses revealed that among both adults and minors considerable scope remained for behavioral health care carve outs to make profits or losses after risk adjustment based on differential enrollment of severely ill patients. Similarly, integrated health plans have strong financial incentives to avoid MH/SA users even after adjustment. CONCLUSIONS:Current risk adjustment methodologies do not eliminate the financial incentives for integrated health plans and behavioral health care carve-out plans to avoid high-utilizing patients with psychiatric disorders.
journal_name
Health Serv Resjournal_title
Health services researchauthors
Ettner SL,Frank RG,McGuire TG,Hermann RCkeywords:
subject
Has Abstractpub_date
2001-08-01 00:00:00pages
793-811issue
4eissn
0017-9124issn
1475-6773journal_volume
36pub_type
杂志文章abstract：OBJECTIVE:To efficiently estimate race/ethnicity using administrative records to facilitate health care organizations' efforts to address disparities when self-reported race/ethnicity data are unavailable. DATA SOURCE:Surname, geocoded residential address, and self-reported race/ethnicity from 1,973,362 enrollees of a...
journal_title：Health services research
pub_type： 杂志文章
doi：10.1111/j.1475-6773.2008.00854.x
更新日期：2008-10-01 00:00:00
abstract：:A model is described that predicts hospital census and computes, for each day, the number of elective admissions that will maximize the census over the short run, subject to constraints on the probability of overflow. Where a computer is available the model provides detailed predictions of census in units as small as ...
journal_title：Health services research
pub_type： 杂志文章
doi：
更新日期：1977-01-01 00:00:00
abstract：OBJECTIVES:(1) To identify resident and organizational factors associated with the use of advance care plans pre- and post-implementation of the Patient Self-Determination Act (PSDA), and (2) to identify changes (pre- and post-implementation of the PSDA) in the relationship between these factors and the use of advance ...
journal_title：Health services research
pub_type： 杂志文章
doi：
更新日期：1998-04-01 00:00:00
abstract：OBJECTIVE:To determine the extent to which the elimination of behavioral health benefits for selected beneficiaries of Oregon's Medicaid program affected general medical expenditures among enrollees using outpatient mental health and substance abuse treatment services. DATA SOURCE/STUDY SETTING:Twelve months of claims...
journal_title：Health services research
pub_type： 杂志文章
doi：10.1111/j.1475-6773.2008.00844.x
更新日期：2008-08-01 00:00:00
abstract：OBJECTIVE:To evaluate episode-based payments for upper respiratory tract infections (URI) and perinatal care in Arkansas's Medicaid population. STUDY SETTING:Upper respiratory infection and perinatal episodes among Medicaid-covered individuals in Arkansas and comparison states from fiscal year (FY) 2011 to 2014. STUD...
journal_title：Health services research
pub_type： 杂志文章
doi：10.1111/1475-6773.13296
更新日期：2020-08-01 00:00:00
abstract：OBJECTIVE:To quantify between-unit variability in mean length of stay (LoS) between intensive care units (ICUs) after adjusting for differences in case mix using a method that does not require arbitrary trimming of data. SETTING:An analysis of registry data from pediatric ICUs (PICUs) in Australia and New Zealand. ST...
journal_title：Health services research
pub_type： 杂志文章
doi：10.1111/j.1475-6773.2012.01421.x
更新日期：2012-12-01 00:00:00
abstract：OBJECTIVE:To compare the estimated effects of dialysis center profit status on patient survival using alternative estimation strategies with retrospective data. DATA SOURCES/STUDY SETTING:Patient and provider-level retrospective data from the United States Renal Data System (USRDS), 1996-1999. STUDY DESIGN:Observatio...
journal_title：Health services research
pub_type： 杂志文章
doi：10.1111/j.1475-6773.2006.00581.x
更新日期：2006-12-01 00:00:00
abstract：OBJECTIVE:To describe differences in patient experiences of hospital care by preferred language within racial/ethnic groups. DATA SOURCE:2014-2015 HCAHPS survey data. STUDY DESIGN:We compared six composite measures for seven languages (English, Spanish, Russian, Portuguese, Chinese, Vietnamese, and Other) within appl...
journal_title：Health services research
pub_type： 杂志文章
doi：10.1111/1475-6773.13105
更新日期：2019-02-01 00:00:00
abstract：OBJECTIVE:To explore why and how health systems are engaging in care delivery redesign (CDR)-defined as the variety of tools and organizational change processes health systems use to pursue the Triple Aim. STUDY SETTING:A purposive sample of 24 health systems across 4 states as part of the Agency for Healthcare Resear...
journal_title：Health services research
pub_type： 杂志文章
doi：10.1111/1475-6773.13585
更新日期：2020-12-01 00:00:00
abstract：OBJECTIVE:To examine the factors associated with delivery of preterm infants at neonatal intensive care unit (NICU) hospitals in Arkansas during the period 2001-2006, with a focus on the impact of a Medicaid supported intervention, Antenatal and Neonatal Guidelines, Education, and Learning System (ANGELS), that expande...
journal_title：Health services research
pub_type： 杂志文章
doi：10.1111/j.1475-6773.2011.01249.x
更新日期：2011-08-01 00:00:00
abstract：OBJECTIVE:To examine how case managers in a state-funded home care program allocate home care services in response to information about a client's Medicare home health care status, with particular attention to the influence of work environment. DATA SOURCES/STUDY SETTING:Primary data collected on 355 case managers and...
journal_title：Health services research
pub_type： 杂志文章
doi：10.1111/1475-6773.00176
更新日期：2003-10-01 00:00:00
abstract：OBJECTIVE:To understand public attitudes about and recommendations to address antibiotic overuse by employing public deliberation (a method for eliciting informed input on value-laden issues). DATA SOURCES/STUDY SETTING:Participants in 24 Community Deliberation groups (CD; n = 263), four Citizens' Panel groups (CP; n ...
journal_title：Health services research
pub_type： 杂志文章
doi：10.1111/1475-6773.13175
更新日期：2019-12-01 00:00:00
abstract：OBJECTIVE:To explore state patterns in the racial life expectancy gap. DATA SOURCES:The 1997-2004 Multiple Cause of Death PUF, 2000 U.S. Census. STUDY DESIGN:We calculated life expectancy at birth for black and white men and women. DATA EXTRACTION METHODS:Data were obtained by the NCHS and U.S. Census Bureau. PRINC...
journal_title：Health services research
pub_type： 杂志文章
doi：10.1111/j.1475-6773.2011.01345.x
更新日期：2012-02-01 00:00:00
abstract：OBJECTIVE:To describe the key features of the first three Cash and Counseling demonstration programs and identify those which the programs have in common and those on which they differ. STUDY SETTING:Demonstration Cash and Counseling programs in Arkansas, Florida, and New Jersey. DATA SOURCES:Interviews with program ...
journal_title：Health services research
pub_type： 杂志文章
doi：10.1111/j.1475-6773.2006.00677.x
更新日期：2007-02-01 00:00:00
abstract：OBJECTIVES:To provide updated estimates of narrow- and broad-spectrum antibiotic use among U.S. children. DATA SOURCES:Linked nationally representative data from the 2004-2010 Medical Expenditure Panel Survey Household Component and the 2000 Decennial Census. STUDY DESIGN:Relationships between individual-, family-, a...
journal_title：Health services research
pub_type： 杂志文章
doi：10.1111/1475-6773.12260
更新日期：2015-06-01 00:00:00
abstract：:OBJECTIVE. : To determine whether racial/ethnic disparities in colonoscopy use vary by physician availability. DATA SOURCE. : We used 100 percent Texas Medicare claims data for 2003-2007. STUDY DESIGN. : We identified beneficiaries aged 66-79 in 2007, examined racial/ethnic differences in colonoscopy use from 2003 to ...
journal_title：Health services research
pub_type： 杂志文章
doi：10.1111/j.1475-6773.2011.01355.x
更新日期：2012-06-01 00:00:00
abstract：OBJECTIVE:Our research compares health care use by Medicaid beneficiaries with that of the uninsured and the privately insured to measure the program's effect on access to care. DATA SOURCES/STUDY SETTING:Data include the 1987 National Medical Expenditure Survey and the Survey of Income and Program Participation for 1...
journal_title：Health services research
pub_type： 杂志文章
doi：
更新日期：1996-02-01 00:00:00
abstract：OBJECTIVE:To examine the effect of worker heterogeneity, firm size, and establishment size on the breadth of employer health insurance offerings. DATA SOURCES:The data were drawn from the 1993 Robert Wood Johnson Foundation Employer Health Insurance Survey of 22,000 business establishments selected randomly from ten s...
journal_title：Health services research
pub_type： 杂志文章
doi：
更新日期：2001-10-01 00:00:00
abstract：OBJECTIVES:To test whether state Certificate of Need (CON) regulations influence procedural mortality or the provision of coronary artery bypass graft surgery (CABG) and percutaneous coronary interventions (PCI). DATA SOURCES:Medicare inpatient claims obtained for 1989-2002 for patients age 65+ who received CABG or PC...
journal_title：Health services research
pub_type： 杂志文章
doi：10.1111/j.1475-6773.2008.00933.x
更新日期：2009-04-01 00:00:00
abstract：OBJECTIVE:To assess the impact of out-migration of nurses on the health systems in sub-Saharan Africa (SSA). SETTING:The countries of SSA. DESIGN AND METHODS:Review of secondary sources: existing publications and country documents on the health workforce; documents prepared for the Joint Learning Initiative Global Hu...
journal_title：Health services research
pub_type： 杂志文章
doi：10.1111/j.1475-6773.2007.00712.x
更新日期：2007-06-01 00:00:00
abstract：OBJECTIVE:To examine the relationship of services for post-acute care (PAC) to stroke patient outcomes. DATA SOURCES/STUDY SETTING:Veterans Health Administration (VHA) hospitals from two facility-level surveys and extant data files. STUDY DESIGN:Cross-sectional study of veterans hospitalized with acute stroke during ...
journal_title：Health services research
pub_type： 杂志文章
doi：
更新日期：2001-02-01 00:00:00
abstract：OBJECTIVE:Microsimulation was used to assess the financial impact on hospitals of a surge in influenza admissions in advance of the H1N1 pandemic in the fall of 2009. The goal was to estimate net income and losses (nationally, and by hospital type) of a response of filling unused hospital bed capacity proportionately a...
journal_title：Health services research
pub_type： 杂志文章
doi：10.1111/1475-6773.12041
更新日期：2013-04-01 00:00:00
abstract：OBJECTIVE:To assess optimal activity size/mix of Connecticut local public health jurisdictions, through estimating economies of scale/scope/specialization for environmental inspections/services. DATA SOURCES/STUDY SETTING:Connecticut's 74 local health jurisdictions (LHJs) must provide environmental health services, bu...
journal_title：Health services research
pub_type： 杂志文章
doi：10.1111/1475-6773.12740
更新日期：2017-12-01 00:00:00
abstract：OBJECTIVE:To review two indirect methods, geocoding and surname analysis, for estimating race/ethnicity as a means for health plans to assess disparities in care. STUDY DESIGN:Review of published articles and unpublished data on the use of geocoding and surname analyses. PRINCIPAL FINDINGS:Few published studies have ...
journal_title：Health services research
pub_type： 杂志文章,评审
doi：10.1111/j.1475-6773.2006.00551.x
更新日期：2006-08-01 00:00:00
abstract：BACKGROUND:Patients are treated using observation services (OS) when their care needs exceed standard outpatient care (i.e., clinic or emergency department) but do not qualify for admission. Medicare and other private payers seek to limit this care setting to 48 hours. DATA SOURCE/STUDY SETTING:Healthcare Cost and Uti...
journal_title：Health services research
pub_type： 杂志文章
doi：10.1111/1475-6773.12143
更新日期：2014-06-01 00:00:00
abstract：:Based on organization theory and the work of Roemer and Friedman, seven dimensions of hospital medical staff organization structure are proposed and examined. The data are based on a 1973 nationwide survey of hospital medical staffs conducted by the American Hospital Association. Factor analysis yielded six relatively...
journal_title：Health services research
pub_type： 杂志文章
doi：
更新日期：1979-07-01 00:00:00
abstract：RESEARCH OBJECTIVE:To investigate disenrollment from public insurance at the 6-year transitional birthday when eligibility for many children moves from Medicaid to State Children's Health Insurance Program (S-CHIP). DATA SOURCES:Data from Georgia's S-CHIP (PeachCare) and Medicaid programs from 2000 to 2002. STUDY DES...
journal_title：Health services research
pub_type： 杂志文章
doi：10.1111/j.1475-6773.2007.00795.x
更新日期：2007-12-01 00:00:00
abstract：OBJECTIVE:To demonstrate how expanding services covered by a "bundled payment" can also expand variation in the costs of treating patients under the bundle, using the Medicare dialysis program as an example. DATA SOURCES/STUDY SETTING:Observational claims-based study of 197,332 Medicare hemodialysis beneficiaries enro...
journal_title：Health services research
pub_type： 杂志文章
doi：10.1111/1475-6773.12202
更新日期：2014-12-01 00:00:00
abstract：OBJECTIVE:To investigate whether the interaction between individual race/ethnicity and community racial/ethnic composition is associated with health-related home care use among elderly persons in the United States. DATA SOURCES:A nationally representative sample of community-dwelling elders aged 65+ from the 2000 to 2...
journal_title：Health services research
pub_type： 杂志文章
doi：10.1111/j.1475-6773.2010.01135.x
更新日期：2010-10-01 00:00:00
abstract：:This article examines factors related to hospital closures, using a longitudinal sample of surviving and closed hospitals. The hospitals are drawn from three states with different regulatory programs. Size of hospital and occupancy rate are shown to be related to likelihood of closure, while ownership, length of stay,...
journal_title：Health services research
pub_type： 杂志文章
doi：
更新日期：1983-01-01 00:00:00
