The American journal of managed care
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Guidelines for the treatment of community-acquired pneumonia (CAP) have been issued by various institutions. These therapeutic recommendations, culled from available medical literature, can be conflicting and confusing. ⋯ Moreover, costs of care and clinical outcomes can vary significantly with therapeutic approaches. All of these factors point to a critical need for more consistent medical guidelines for treating CAP.
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Comparative Study
Comparing the medical expenses of children with Medicaid and commercial insurance in an HMO.
In recent years, growing numbers of children with Medicaid have been enrolled in managed care plans nationwide. Yet, large, commercial managed care plans are increasingly discontinuing their participation in Medicaid because of low Medicaid payment rates. ⋯ The costs of income-eligible, Medicaid-insured children in this HMO were similar to those of commercially insured children, but the costs for the medically needy and the blind and disabled were substantially higher.
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The challenges of Medicaid managed care organizations that serve blind and disabled members are reviewed. Beneficiary satisfaction and access to care are assessed, and access problems are identified and resolved or minimized to the greatest degree possible. ⋯ Factors found to be associated with the success of a Medicaid managed care program serving blind and disabled beneficiaries include educating the members and providers for better understanding of managed care, incorporating collaborative service improvement activities, and documenting trends.
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Comparative Study
The impact of an inpatient physician program on quality, utilization, and satisfaction.
To evaluate an inpatient physician system initiated in June 1996 for all patients of a health maintenance organization admitted to the general medicine service of an urban teaching hospital. In the new program, attending physician duties were transferred from the patient's own general internist to another internist serving on a hospital-based rotation. ⋯ Implementation of an inpatient physician program at this institution significantly decreased resource utilization while maintaining or improving quality of care. Satisfaction with the program was high among primary care internists and housestaff.
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To project the impact of maintaining long-term glycemic control (i.e., a sustained reduction in glycosylated hemoglobin (hemoglobin A1c [HbA1c]) on the lifetime incidence and direct medical costs of complications in persons with type 2 diabetes. ⋯ Maintaining long-term glycemic control reduces complication rates and costs for medical care for all ethnic groups regardless of age at diagnosis. Relatively greater benefit is achieved by interventions targeting Hispanics and younger, newly diagnosed persons.