Authors: Szilagyi PG, Shenkman E, Brach C, et al.
Title: Children with special health care needs enrolled in SCHIP: patient characteristics and health care needs.
Publication: Pediatrics 112(6 Pt. 2):508-20.
Abstract: Available on PubMed®.
Availability: Reprints of this article can be ordered from the AHRQ Publications Clearinghouse (1-800-358-9295, AHRQ Publication No. 04-RO17).
Authors: Shone LP, Dick AW, Brach C, et al.
Title: The role of race and ethnicity in SCHIP in four states: are these baseline disparities, and what do they mean for SCHIP?
Publication: Pediatrics 112(6):521-32.
Abstract: Available on PubMed®.
Availability: Reprints of this article can be ordered from the AHRQ Publications Clearinghouse (1-800-358-9295, AHRQ Publication No. 04-RO16).
Authors: Brach C, Lewit EM, VanLandeghem K, et al.
Title: Who's enrolled in SCHIP? Findings from the Child Health Insurance Research Initiative (CHIRI™).
Publication: Pediatrics 112(6):499-507.
Abstract: Available on PubMed®
Availability: Reprints of this article can be ordered from the AHRQ Publications Clearinghouse (1-800-358-9295, AHRQ Publication No. 04-RO15).
Authors: Dick AW, Allison RA, Haber SG, Brach C, Shenkman B
Title: Consequences of States' Policies for SCHIP Disenrollment.
Publication: Health Care Financing Review 23(3):65-88.
Abstract: Policymakers are concerned about disenrollment from the State Children's Health Insurance Program (SCHIP). We describe disenrollment in Florida, Kansas, New York, and Oregon and assess the links between disenrollment and states' SCHIP policies. We find that SCHIP is used on a long-term basis (at least 2 years) for a significant group of new enrollees and as temporary coverage (fewer than 12 months) for many others. Recertification generates large disenrollments (about half of children still enrolled at the time), but as many as 25 percent return within 2 months. The increased disenrollment rate at recertification is completely eliminated by a policy of passive re-enrollment.
Availability: AHRQ Publication No. 02-R070 is available from the AHRQ Publications Clearinghouse.
Authors: Spector W., Mukamel D.
Title: Nursing home administrators' perceptions of competition and strategic responses.
Publication: Long Term Care Interface 2001 Mar;2(3):37-41.
Abstract: This paper presents findings from a 1999 mailed survey of nursing home administrators in New York State, designed to elicit their perceptions of competition in the nursing home market and their strategic plans to cope with changing market conditions. Results show that administrators think that nursing home markets have become more competitive and expect this trend to continue. They perceive differences in the way individual customers choose nursing homes versus the way MCOs and hospitals make such choices. They believe that individual consumers place a higher value on quality of life factors, while aggregate purchasers rate price and the availability of complex sub-acute services higher. Strategic responses by nursing homes varied by ownership type.
Authors: Friedman B, Jee J., Steiner C, et al.
Title: Tracking the State Children's Health Insurance Program with hospital data: National baselines, State variations, and some cautions.
Publication: Med Care Res Rev 56(4):440-55.
Abstract: State and Federal agencies are concerned with the impact of the State Children's Health Insurance Program (SCHIP) on the health care of enrolled children. As part of a broad program evaluation, and at relatively low cost, analysts can track data on hospital admissions for ambulatory care sensitive (ACS) conditions. This article uses hospital data for 19 states to calculate baseline ACS rates and to discuss trends and cross-state variations just prior to the start of SCHIP. A few cautions and limitations are discussed. An unexpected result in the explorations was a substantial increase in the rate of ACS admissions for self-pay and Medicaid-enrolled children during the period of 1990-1995. During that same period, the admission rate for other insured children fell by more than a third. The comparisons across states are meant to be illustrative; they do reveal a relationship between the rate of asthma admissions and the proportion of self-pay plus Medicaid-enrolled cases.
Availability: AHRQ Pub. No. 00-R009 is available from the AHRQ Publications Clearinghouse.
Authors: Harris-Kojetin L, Fowler F, Schnaier J, et al.
Title: The use of cognitive testing for developing and evaluating CAHPS® survey
Publication: Med Care 37(3 Suppl):MS10-MS21.
The main goal of the Consumer Assessments of Health Plans (CAHPS®) survey
is to develop an integrated set of tested, standardized surveys to obtain
meaningful information from health plan enrollees about their experiences.
The CAHPS® project benefits from the complementary strengths of psychometric
and cognitive testing. The authors found that cognitive testing was integral
in developing and refining the CAHPS® instrument. The cognitive
testing findings contributed to an improved instrument that should capture
consumers' health care and plan experiences with less response error than
one not subjected to such testing.
Authors: Fraser I, Chait E, Brach C.
Title: Promoting choice: Lessons
from managed Medicaid programs.
Publication: Health Aff 17(5):165-73.
Abstract: By examining the experiences of seven States with mandatory managed
Medicaid programs, this article seeks to draw some lessons and raise research,
policy, and operational questions about enrollee choice of health plans.
The article explores the strategies States adopt to inform and facilitate
choice, and what methods they use to assign individuals who do not make
a choice in the time allotted. Differences are identified in the enrollment
and education process that might account for some of the variation among
States' rates of enrollees who choose a plan. Use of enrollment brokers
and restrictions on marketing is also discussed.
Availability: AHCPR Publication No. 98-R088 is available from the AHRQ Publications Clearinghouse.
Authors: Friedman B, Devers K, Hellinger F, et al.
Title: Carve outs
and related models of contracting for speciality care: Framework and highlights
of a workshop.
Publication: American Journal of Managed Care 4(Special Issue).
Abstract: This article provides an overview of papers presented at a workshop
sponsored by AHCPR in January, 1998. The papers, published in this special issue of the American Journal
of Managed Care, focus on one set of strategies: the use of carve outs
and related models of contracting for specialty care. The defining common
feature of these contracts is that they engage providers and management
entities different from those otherwise available to care for the
same patients within a health plan. The other common feature of these arrangements
is that they receive significant attention in the marketplace and
almost no attention from research. The purpose of the workshop and this
special issue of the American Journal of Managed Care is to identify
what is known and not known about these arrangements and develop an agenda
for future research.
Availability: AHCPR Publication No. 98-R080 is available from the AHRQ Publications
Author: Hellinger F.
Title: Regulating the financial incentives facing physicians
in managed care plans.
Publication: American Journal of Managed Care 4(5):663-74.
Recent accounts of enrollees in managed care plans being denied access
to potentially lifesaving services have heightened public anxiety about
the impact of managed care on the accessibility and appropriateness of
care, This anxiety has been translated into legislative action. The
present review focuses on an area of managed care operations that has received
considerable attention in State legislatures and in Congress during the
past 2 years: the financial relationship between managed care health
plans and physicians. Twelve States now mandate that managed care plans
disclose information about their financial relationship with physicians,
and 11 States regulate the method used by managed care health plans
to compensate physicians. Most laws that regulate methods of compensation
prohibit health plans from providing physicians an inducement to reduce
or limit the delivery of "medically necessary" services. Moreover, in 1996
the Health Care Financing Administration (HCFA) finalized its regulations governing
the financial incentives facing physicians in plans that treat Medicaid
or Medicare patients, and these regulations went into effect on January
1, 1997. These regulations are also examined in this study.
Availability: AHCPR Publication No. 98-R064 is available from the AHRQ Publications Clearinghouse.
Authors: Fraser I, Brach C.
Title: Meeting Medicaid's cost and quality
challenges: The role of AHRQ research.
Abstract: This Program Note describes AHCPR's role in providing research and technical
assistance to the Medicaid program in six areas: care for elderly and disabled
populations, maternal and child health, HIV and AIDS, drug policy, informing
consumers, and system financing and management.
Availability: AHCPR Publication No. 97-0044 is available from the AHRQ Publications Clearinghouse. Online version.
Authors: Robinson G, Brach C.
Title: Managed mental health care and
women: Implications of a changing delivery system.
Publication: Paper read at Changes
in Mental Health Care: What Might They Mean for Women?
Date: October 2, 1996
This article was written to serve as the basis of discussion for the Commonwealth
Fund Commission on Women's Health's symposium, Changes in Mental Health
Care: What Might They Mean for Women? The public mental health system
is now undergoing a radical transformation with the advent of managed care.
Over the past two decades Medicaid has grown into a dominant funding source
for public mental health services. States, facing budgetary pressures,
are increasingly shifting Medicaid programs into managed care.
Author: Spector W, Cohen J.
Title: The effect of Medicaid reimbursement
on quality of care in nursing homes.
Publication: Journal of Health Economics 1996;15:23-48.
Abstract: This study uses a nationally representative sample of nursing homes
and nursing home residents to examine the effect of Medicaid reimbursement
on quality of care. The analysis shows that both reimbursement approach
and level affect nursing home quality, as measured by case-mix adjusted
staff to resident ratios. The analysis also shows that staffing ratios
have an impact on resident outcomes, and these impacts vary by professional
category of staff.
Availability: AHCPR Publication No. 96-R116 is available from
the AHRQ Publications Clearinghouse.
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