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Changing Medication Use in Managed Care: A Critical Review of the Available Evidence (PDF)

17 pages. Excerpt: Objective: To review the effectiveness of strategies to improve the quality and efficiency of medication use in managed careorganizations (MCOs).

Improve American Health Care by Moving Away from Employer-Sponsored Insurance

"Health care financed by insurance represents a major portion of the economy in America, and more than half of people with insurance are covered by their employer. For employers, approximately 30% of employee expenses go to benefits, of which health insurance is the largest component.... The major problem with this is that ESI leads to lower-quality, higher-cost health care while hurting the employer's productivity."

Impact of Two Employer-Sponsored Population Health Management Programs on Medical Care Cost and Utilization (PDF)

8 pages. Excerpt: Conclusions: Our results suggest that the programs did not reduce medical cost in their first year, despite a beneficial effect on hospital admissions. If we had been able to include program fees, it is likely that the overall cost would have increased significantly. Although this study had important limitations, the results suggest that a belief that these programs will save money may be too optimistic and better evaluation is needed.

The Value Proposition in Healthcare (PDF)

2 pages. Excerpt: To engage our readers in lively discussion, The American Journal of Managed Care is inaugurating a series of editorials on value in healthcare. This month, Richard T. Clark, CEO of Merck & Co., provides his perspective. We invite you to share your thoughts with us about how value affects your industry, practice, and everyday lives.

Legal Issues in Value-Based Care Contracts for Self-Insured Employers

"Implementing a value-based contract that ties payments to quality metrics or population health outcomes creates several fiduciary questions. Does shifting risk to a provider expose plan participants to narrower networks or limited access that may conflict with fiduciary obligations? How should fiduciaries evaluate whether the incentive structures truly benefit plan participants rather than merely reduce employer costs? ... Using standardized CMS data sets minimizes ambiguity and improves objective benchmarking. From a legal point of view, incorporating CMS data sets requires careful implementation. "

Personal Health Records Could Produce Lower Health Care Costs

"Among American healthcare consumers, considerable interest exists in integrated personal health records (PHRs).... In a national survey, the majority of respondents reported the belief that online access to health information would have personal benefits that would improve the quality of healthcare. People pay more attention to and become more engaged in their health and medical care when they have easy online access to their health information."

A Bundle of Joy? Bundled Payments for Maternity Care

"As a time-limited condition, maternity care may be uniquely well-suited for bundled payment models... [A] range of different stakeholders -- from health plans ... to self-insured employers ... to freestanding birth centers ... are all piloting bundled payment models for maternity care.... The innovators in maternity care bundled payments vary widely in their approaches[.]"

Trends in Hospital-Based Childbirth Care: The Role of Health Insurance

"US hospital-based births covered by private insurance were associated with higher rates of obstetric intervention than births paid for by Medicaid. After controlling for clinical, demographic, and hospital factors, cesarean delivery rates increased more rapidly among births covered by private insurance, compared with Medicaid. Changes in insurance coverage associated with healthcare reform may impact costs and quality of care for women giving birth in US hospitals."

The Promise and Peril of Health Care Forecasting

"The growing use and increased sophistication of electronically mediated patient-level forecasting presents challenges for ethical use and opportunities for innovative applications. Health plans, method developers, and policy makers should adopt strategies that directly address these issues in order to maximize the benefit of healthcare forecasting on the longterm health of patients."

The Value of Ambulatory Care Measures: A Review of Clinical and Financial Impact from an Employer/Payer Perspective (PDF)

9 pages. Excerpt: Given the current emphasis on pay-for-performance and pay-for-reporting programs, and recent studies showing a lack of relationship between measures and clinical/economic value, this analysis informs payers, purchasers, providers, and policymakers about the importance of choosing the right metrics and the methods for collecting them.