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Skip Navigation U.S. Department of Health and Human Services
Agency for Healthcare Research Quality

Managed Care

Research Findings

Research Activities, August 2008:
University's open season shows embrace of preferred provider organizations but no backlash against HMOs

Research Activities, July 2008:
Children with private insurance have better access to specialty care than those with public and no insurance

Research Activities, February 2008:
Children with special health care needs seem to benefit from Medicaid managed care programs with case managers
Studies examine the impact of nurse staffing on complications, mortality, and length of hospital stay
Managed care helps the elderly avoid preventable hospitalizations more than traditional Medicare

Research Activities, November 2007:
Caregivers of children with special health care needs rate Medicaid managed care as having better care access than fee-for-service
Postdischarge care management that integrates medical and social care can improve outcomes of the low-income elderly
California Medicaid managed care plans would like to increase chronic disease care management programs

Research Activities, October 2007:
Studies show lower colorectal cancer screening rates and access to surgery among the poor, minority, and uninsured

Research Activities, September 2007:
Women in Medicare and private managed care plans receive worse care than men for cardiovascular disease and diabetes
Physicians seem to manage potential conflicts with managed care financial arrangements to retain patient trust

Research Activities, August 2007:
Price competition induced by HMOs and other managed care plans in California has not diminished hospital quality of care
Socioeconomically disadvantaged patients with lupus have less access to and use of health care
Education, income, and wealth all affect medical care expenditures among Medicare managed care members

Research Activities, June 2007:
Reduced payments to hospitals may jeopardize patient safety
A managed care model and care coordination can reduce emergency department use among children with special health care needs
Better outpatient care processes can improve the quality of life for patients with chronic disease

Research Activities, May 2007:
A study of one managed behavioral health care organization does not show a shift in treatment costs to drugs and primary care

Research Activities, March 2007:
Studies highlight the interaction between managed care and market forces and their impact on quality of care
State Children's Health Insurance Programs have improved access to care for previously uninsured children
Factors such as disease status and sex affect adherence to drug prescribing guidelines for hypertension

Research Activities, February 2007:
Some pregnant women are still prescribed medications with the potential to harm the fetus
Computerized and age-specific drug alerts can reduce both inappropriate prescribing of drugs and unnecessary drug alerts

Research Activities, January 2007:
African-American physicians were much more likely than white physicians to practice in HMOs in the 1990s
Most quality improvement strategies produce only small to modest improvements in glycemic control among patients with diabetes

Research Activities, November 2006:
Uninsured children's access to care is influenced by the availability and capacity of a local safety net
HMOs do not appear to adversely affect the health of the near-elderly and may benefit those with chronic health conditions

Research Activities, October 2006:
Severity of illness and rural location affect the willingness of elderly people to travel longer distances to the hospital
Greater competition among health plans is linked to more advertising that targets healthier patients

Research Activities, September 2006:
Previous hospital performance, internal operations, and market competition are key in improving hospital performance

Research Activities, August 2006:
Studies highlight the value of the Medical Expenditure Panel Survey to inform trends in care costs, coverage, use, and access

Research Activities, July 2006:
Doctors often fail to order laboratory monitoring when elderly HMO outpatients begin cardiovascular medications
Reductions in primary and preventive care use under Medicaid primary care case management are more dramatic for minority children

Research Activities, June 2006:
Primary care physician and health care system characteristics influence the likelihood of referral to specialists
A practice-based research cohort of patients may have advantages over the traditional PBRN model

Research Activities, May 2006
Medicaid may reduce racial/ethnic differences in preventable hospitalizations, but Medicaid managed care adds no extra benefit
Medicaid managed care plans with case management programs may benefit children with disabilities more than fee-for-service plans
Greater Medicare HMO penetration is associated with a shift in elderly stroke deaths from hospital to non-hospital settings

Research Activities, April 2006
New information will help health care providers adopt health information technologies

Research Activities, March 2006
Some for-profit Medicare health plans provide lower quality of care than not-for-profit plans
Medi-Cal changes in the 1990s shifted newborn deliveries from large public hospitals to smaller community hospitals

Research Activities, February 2006:
Employer-offered health coverage affects plan uptake by workers, but has less effect on overall worker and family coverage rates

Research Activities, January 2006:
Studies examine the impact of Medicaid managed care programs on access to and use of care

Research Activities, December 2005:
Neither patient HMO membership nor physician HMO participation is greatly associated with racial disparities in primary care

Research Activities, October 2005:
Level of HMO penetration in a hospital's market affects the relationships between nurse staffing, length of stay, and mortality

Research Activities, August 2005:
Certain managed care organization characteristics can increase specialty care use among chronically ill low-income children
Study explores physician job satisfaction and quality of care and outcomes for managed care patients with pain and depression

Research Activities, July 2005:
Both group and individual academic detailing can improve prescribing of antihypertensive medications
Older people in HMOs and PPOs use more outpatient and preventive services than those in fee-for-service plans
Study questions whether competition among HMOs will inherently improve care quality

Research Activities, June 2005:
Despite predictions of the end of managed care, enrollment in HMO plans has stayed relatively constant in recent years
High managed care penetration boosts breast and cervical cancer screening, with spillover effects to non-managed care patients

Research Activities, May 2005:
HMO penetration in a hospital's market affects the relationship between RN staffing and quality of care

Research Activities, April 2005:
Being organized as a group/staff HMO generally has a stronger impact on care access and quality than capitation

Research Activities, March 2005:
Health plans take action to improve services for members with limited English proficiency
Minority physicians in Maryland are more likely than white physicians to be denied managed care contracts

Research Activities, February 2005:
Adoption of medical innovation, which is driving much of health care costs, is largely outside the control of health plans
Policies that have a deductible inserted in the middle instead of at the front expose enrollees to more risk

Research Activities, January 2005:
Medicare managed care enrollees make significant use of home health benefits, but low education limits use of medical equipment
During the mid-1990s, Medicare HMOs in California reduced inpatient use beyond that attributable to favorable selection

Research Activities, December 2004:
When managed care market share increases in a geographic area, procedures decrease for Medicare fee-for-service patients

Research Activities, November 2004:
Volume and intensity of physicians' services used by FFS Medicare enrollees jumped over 30 percent in the mid-1990s

Research Activities, October 2004:
Latinos benefit more than whites from psychotherapy-based quality improvement for depression, and they have lower costs for care
Large firms are more likely to offer health insurance plans with high quality ratings

Research Activities, September 2004:
Potentially preventable hospital readmissions may be determined by the severity and complexity of underlying chronic problems
Children with special health care needs in Medicaid managed care plans receive more needed care than those in Medicaid FFS plans

Research Activities, August 2004:
Ethnicity, income, and public financing all influence medical safety net providers in large urban communities

Research Activities, July 2004:
People who switch health plans often do not have to change physicians
Inner-city parents often have limited knowledge about managed care rules and practices
Disparities in use of preventive care may be reduced by requiring Medicare HMO enrollees to select a primary care doctor
Medicare managed care is better at delivering preventive services, but traditional Medicare is better in other areas
More restrictive laws and consumer and investor anxiety have had an effect on managed care cost-cutting strategies

Research Activities, June 2004:
People with diabetes do a better job of managing their disease when HMOs cover diabetes self-monitoring devices
Most appeals to two of the Nation's largest HMOs to cover emergency care are resolved in favor of patients
Despite some slowing, the growth in drug expenditures continues to outpace growth in overall health care expenditures

Research Activities, May 2004:
Jaundice and feeding problems are not associated with short hospital stays, as long as newborns are evaluated at 3 or 4 days of life
Health care costs are lower in Minnesota than in other States due mostly to structural factors, not financial incentives
Young and healthy individuals fare better than moderately sick individuals with consumer-directed health benefits
Greater HMO penetration in an area reduces the number of preventable hospitalizations

Research Activities, April 2004:
Medicare enrollees in for-profit plans are no less likely to receive high-cost procedures than those in non-profit plans
Health plan use of gatekeepers may improve use of recommended cancer screening

Research Activities, March 2004:
Researchers examine the management of chronic illness in managed care settings

Research Activities, February 2004:
Being a salaried physician in a large office may be the chief source of physician dissatisfaction with managed care
Some managed care strategies to improve drug use appear to be effective, but little is known about long term clinical outcomes


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