The American journal of managed care
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To examine whether physicians who sought and received Bridges to Excellence (BTE) recognition performed better than similar physicians on a standardized set of population-based performance measures. ⋯ Our findings suggest that the BTE approach to ascertaining physician quality identifies physicians who perform better on claims-based quality measures and primary care physicians who use a less resource-intensive practice style.
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To describe patient and healthcare system correlates of receipt of recommended care in North Carolina (NC) as indicated by receipt of adjuvant radiation therapy (RT) after breast-conserving surgery (BCS). ⋯ Some low-income women do not access RT following BCS, placing them at risk for worse outcomes than those associated with standard mastectomy. We identify geographic isolation and scarcity of healthcare specialists as possible leverage points for interventions.
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To examine financial implications of the Centers for Medicare & Medicaid Services Hierarchical Condition Categories (CMS-HCC) risk-adjustment model on Medicare payments for individuals with comorbid chronic conditions. ⋯ Information about beneficiary functional status should be incorporated in reimbursement models. Underpaying providers who care for populations with multiple comorbidities may provide severe disincentives for managed care plans to enroll such individuals and to appropriately manage their complex and costly conditions.