The American journal of managed care
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Despite substantial enthusiasm among insurers and federal policy makers for pay-for-performance incentives, little is known about the current scope of these incentives or their influence on the delivery of care. To assess the scope and magnitude of pay-for-performance (P4P) incentives among physician groups and to examine whether such incentives are associated with quality improvement initiatives. ⋯ P4P incentives are now common among physician groups in Massachusetts, and these incentives most commonly reward higher clinical quality or lower utilization of care. Although the scope and magnitude of incentives are still modest for many groups, we found an association between P4P incentives and the use of quality improvement initiatives.
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Randomized Controlled Trial
Reducing the number of emergency department visits and costs associated with anxiety: a randomized controlled study.
To demonstrate the economic effects of an intervention for members discharged from the emergency department (ED) with anxiety diagnoses. ⋯ The case management-based intervention effectively reduced psychiatric ED recidivism and costs for members discharged from the ED with an anxiety diagnosis, without significantly affecting psychiatric outpatient visit costs.
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To examine the impact of geographic variation on racial differences in 7 of 15 Health Plan Employer Data and Information Set (HEDIS) measures that assess the quality of the Medicare managed care program (also known as Medicare+Choice). ⋯ Removing within-region racial variation while ignoring geographic differences will not equalize the experiences of black and white elders. Rather, both racial and geographic components of healthcare quality must be addressed if the Medicare managed care program is to provide care of equal quality to all elders regardless of race.
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Coronary heart disease (CHD) remains the leading cause of mortality in the United States, and factors such as age, gender, or race/ethnicity have a significant impact on cardiovascular risk. More than 80% of people who die from CHD are 65 years or older. Because women experience myocardial infarction (MI) at older ages than men, their mortality from MI is greater than it is for men. ⋯ Given this information, aggressive treatment of CHD risk factors is critical in black individuals, older individuals, and women. Although abundant randomized, controlled clinical data exist to support the efficacy of lipid-lowering therapy in preventing CHD events, these populations have traditionally been underrepresented in intervention-based clinical trials, despite their high prevalence of CHD. This article will explore the evidence for instituting statin therapy as part of a risk reducing strategy in older individuals, women, and ethnic minorities.
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To determine whether low-income seniors and those without prescription drug coverage are more likely to use generic cardiovascular drugs than more affluent and better insured adults. ⋯ Seniors with low incomes or no prescription coverage were only somewhat more likely to use generic cardiovascular drugs than more affluent and insured seniors. These findings suggest that physicians and policy makers may be missing opportunities to reduce costs for Medicare and its economically disadvantaged beneficiaries.