keyword
MENU ▼
Read by QxMD icon Read
search

Insurance contracts

keyword
https://www.readbyqxmd.com/read/29317109/the-role-of-the-2011-patients-rights-in-cross-border-health-care-directive-in-shaping-seven-national-health-systems-looking-beyond-patient-mobility
#1
Natasha Azzopardi-Muscat, Rita Baeten, Timo Clemens, Triin Habicht, Ilmo Keskimäki, Iwona Kowalska-Bobko, Anna Sagan, Ewout van Ginneken
Reports on the implementation of the Directive on the application of Patients' Rights in Cross-border Healthcare indicate that it had little impact on the numbers of patients seeking care abroad. We set out to explore the effects of this directive on health systems in seven EU Member States. Key informants in Belgium, Estonia, Finland, Germany, Malta, Poland and The Netherlands filled out a structured questionnaire. Findings indicate that the impact of the directive varied between countries and was smaller in countries where a large degree of adaptation had already taken place in response to the European Court of Justice Rulings...
January 4, 2018: Health Policy
https://www.readbyqxmd.com/read/29311179/medical-interpreters-in-outpatient-practice
#2
Barb Jacobs, Anne M Ryan, Katherine S Henrichs, Barry D Weiss
This article provides an overview of the federal requirements related to providing interpreter services for non-English-speaking patients in outpatient practice. Antidiscrimination provisions in federal law require health programs and clinicians receiving federal financial assistance to take reasonable steps to provide meaningful access to individuals with limited English proficiency who are eligible for or likely to be encountered in their health programs or activities. Federal financial assistance includes grants, contracts, loans, tax credits and subsidies, as well as payments through Medicaid, the Children's Health Insurance Program, and most Medicare programs...
January 2018: Annals of Family Medicine
https://www.readbyqxmd.com/read/29248062/insurers-response-to-selection-risk-evidence-from-medicare-enrollment-reforms
#3
Francesco Decarolis, Andrea Guglielmo
Evidence on insurers' behavior in environments with both risk selection and market power is largely missing. We fill this gap by providing one of the first empirical accounts of how insurers adjust plan features when faced with potential changes in selection. Our strategy exploits a 2012 reform allowing Medicare enrollees to switch to 5-star contracts at anytime. This policy increased enrollment into 5-star contracts, but without risk selection worsening. Our findings show that this is due to 5-star plans lowering both premiums and generosity, thus becoming more appealing for most beneficiaries, but less so for those in worse health conditions...
December 2017: Journal of Health Economics
https://www.readbyqxmd.com/read/29239578/national-vaccination-program-a-success-story-of-public-health-and-economy
#4
Heini Salo, Terhi Kilpi
The savings in treatment costs generated by disease cases prevented by the national vaccination program exceed the costs of the vaccination program by at least 60 million euros. In addition, other costs due to contracting the illness are avoided. Vaccinations serve the purpose of both increasing well-being and releasing resources for other uses. Financial support of vaccinations through the health insurance system would be costly and targetted to those with the ability to pay. Public funds should be directed to the development of a vaccination program...
2017: Duodecim; Lääketieteellinen Aikakauskirja
https://www.readbyqxmd.com/read/29231131/impact-of-accountable-care-organizations-on-utilization-care-and-outcomes-a-systematic-review
#5
Brystana G Kaufman, B Steven Spivack, Sally C Stearns, Paula H Song, Emily C O'Brien
Since 2010, more than 900 accountable care organizations (ACOs) have formed payment contracts with public and private insurers in the United States; however, there has not been a systematic evaluation of the evidence studying impacts of ACOs on care and outcomes across payer types. This review evaluates the quality of evidence regarding the association of public and private ACOs with health service use, processes, and outcomes of care. The 42 articles identified studied ACO contracts with Medicare ( N = 24 articles), Medicaid ( N = 5), commercial ( N = 11), and all payers ( N = 2)...
December 1, 2017: Medical Care Research and Review: MCRR
https://www.readbyqxmd.com/read/29189295/effects-of-global-payment-and-accountable-care-on-medication-treatment-for-alcohol-and-opioid-use-disorders
#6
Julie M Donohue, Colleen L Barry, Elizabeth A Stuart, Shelly F Greenfield, Zirui Song, Michael E Chernew, Haiden A Huskamp
OBJECTIVES: The Alternative Quality Contract (AQC) implemented in 2009 by Blue Cross Blue Shield of Massachusetts (BCBSMA) is intended to improve quality and control costs by putting providers at risk for total medical spending and tying payment to performance on specified quality measures. We examined the AQC's early effects on use of and spending on medication treatment (MT) for addiction among individuals with alcohol use disorders (AUDs) and opioid use disorders (OUDs), conditions not subject to any performance measurement in the AQC...
November 20, 2017: Journal of Addiction Medicine
https://www.readbyqxmd.com/read/29185979/with-direct-contracting-boeing-cuts-out-the-middleman
#7
Joseph Burns
The company has more than 15,000 employees - or about a third of the eligible employees in those four locations - enrolled in direct contracts. Boeing has dubbed the direct contracts its Preferred Partnership health plan. Should insurers worry that other large companies will cut them out?
November 2017: Managed Care
https://www.readbyqxmd.com/read/29172973/ezetimibe-use-and-ldl-c-goal-achievement-a-retrospective-database-analysis-of-patients-with-clinical-atherosclerotic-cardiovascular-disease-or-probable-heterozygous-familial-hypercholesterolemia
#8
Joseph Menzin, Jyoti Aggarwal, Brian Boatman, Jeffrey Yu, Kevin Stern, David J Harrison, Jeetvan G Patel
BACKGROUND: Ezetimibe is recommended by clinical practice guidelines as a second-line therapy for lowering low-density lipoprotein cholesterol (LDL-C) levels, but little is known about its use and effectiveness in real-world populations. OBJECTIVE: To understand the real-world impact of adding or switching to ezetimibe on LDL-C goal achievement in patients with clinical atherosclerotic cardiovascular disease (ASCVD) and/or heterozygous familial hypercholesterolemia (HeFH)...
December 2017: Journal of Managed Care & Specialty Pharmacy
https://www.readbyqxmd.com/read/29171307/pre-injury-job-characteristics-and-return-to-work-among-injured-workers-in-south-korea-differences-by-socio-demographic-and-injury-related-characteristics
#9
Soo Kyung Park, Chung Kwon Lee
PURPOSE: This study examined the effect of pre-injury job characteristics on the odds of RTW outcomes for specific socio-demographic and injury-related characteristics among injured workers in South Korea. METHODS: This study employed first-wave data for 1993 participants from the Panel Study of Workers' Compensation Insurance. A two-step cluster analysis was conducted to profile pre-injury job characteristics, including monthly wages, length of service, company size, contract type, and working hours...
November 24, 2017: Disability and Rehabilitation
https://www.readbyqxmd.com/read/29168257/effect-of-privatized-managed-care-on-public-insurance-spending-and-generosity-evidence-from-medicaid
#10
Victoria Perez
States choose to provide Medicaid coverage via managed care or traditional fee-for-service. Managed care provided by private insurers poses higher contracting costs and information asymmetry than traditional fee-for-service but potentially improves efficiency and reduces spending. Evaluating the effect of managed care on Medicaid spending is challenging because adoption of managed care is nonrandom and may be driven by local economic shocks that simultaneously affect Medicaid spending. This study implements a dynamic panel framework to estimate the effect of managed care enrollment on spending levels and program design...
November 23, 2017: Health Economics
https://www.readbyqxmd.com/read/29163151/ongoing-initiatives-to-improve-the-quality-and-efficiency-of-medicine-use-within-the-public-healthcare-system-in-south-africa-a-preliminary-study
#11
Johanna C Meyer, Natalie Schellack, Jacobus Stokes, Ruth Lancaster, Helecine Zeeman, Douglas Defty, Brian Godman, Gavin Steel
Introduction: South Africa has an appreciable burden of both communicable and non-communicable diseases as well as high maternal, neonatal, and child morbidity. In recent years there have been significant strides with improving the public health system, and addressing current inequalities, with the right to health a constitutional provision in South Africa. Initiatives include the introduction of National Health Insurance, programmes to enhance access to medicines for patients with chronic diseases, as well as activities to improve care in hospitals, including improving pharmacovigilance...
2017: Frontiers in Pharmacology
https://www.readbyqxmd.com/read/29147931/horses-for-courses-moving-india-towards-universal-health-coverage-through-targeted-policy-design
#12
Dayashankar Maurya, Altaf Virani, S Rajasulochana
The debate on how India's health system should move towards universal health coverage was (meant to be) put to rest by the recent National Health Policy 2017. However, the new policy is silent about tackling bottlenecks mentioned in the said policy proposal. It aims to provide universal access to free primary care by strengthening the public system, and to secondary and tertiary care through strategic purchasing from the private sector, to overcome deficiencies in public provisioning in the short run. Yet, in doing so, it ignores critical factors needed to replicate successful models of public healthcare delivery from certain states that it hopes to emulate...
December 2017: Applied Health Economics and Health Policy
https://www.readbyqxmd.com/read/29132634/a-model-to-determine-payments-associated-with-radiology-procedures
#13
Thusitha Mabotuwana, Christopher S Hall, Shiby Thomas, Christoph Wald
OBJECTIVE: Across the United States, there is a growing number of patients in Accountable Care Organizations and under risk contracts with commercial insurance. This is due to proliferation of new value-based payment models and care delivery reform efforts. In this context, the business model of radiology within a hospital or health system context is shifting from a primary profit-center to a cost-center with a goal of cost savings. Radiology departments need to increasingly understand how the transactional nature of the business relates to financial rewards...
December 2017: International Journal of Medical Informatics
https://www.readbyqxmd.com/read/29108987/insurance-related-practices-at-title-x-funded-family-planning-centers-under-the-affordable-care-act-survey-and-interview-findings
#14
Mia R Zolna, Megan L Kavanaugh, Kinsey Hasstedt
INTRODUCTION: Given the recent reforms in the United States health care system, including the passage and implementation of the Affordable Care Act, as well as anticipated upcoming changes to health care coverage, it is critical that publicly funded health care providers understand how to effectively work with their states' Medicaid program and the private health insurance plans in their service area to provide high-quality contraceptive care to the millions of women relying on services at these sites annually...
November 3, 2017: Women's Health Issues: Official Publication of the Jacobs Institute of Women's Health
https://www.readbyqxmd.com/read/29056240/evaluation-of-minimum-volume-standards-for-surgery-in-the-netherlands-2003-2017-a-successful-policy
#15
Roos Mesman, Marjan J Faber, Bart J J M Berden, Gert P Westert
PURPOSE: To evaluate the introduction and implications of minimum volume standards for surgery in Dutch health care from 2003 to 2017 and formulate policy lessons for other countries. SETTING: Dutch health care. PRINCIPAL FINDINGS: Three eras were identified, representing a trust-and-control cycle in keeping with changing roles of different stakeholders in Dutch context. In the first era 'regulated trust' (2003-2009), the Dutch Inspectorate introduced national volume criteria and relied on yearly hospital reported data for information on compliance...
September 29, 2017: Health Policy
https://www.readbyqxmd.com/read/29055519/good-better-best-a-comprehensive-comparison-of-healthcare-providers-performance-an-application-to-physiotherapy-practices-in-primary-care
#16
Sander Steenhuis, Niels Groeneweg, Xander Koolman, France Portrait
Most payment methods in healthcare stimulate volume-driven care, rather than value-driven care. Value-based payment methods such as Pay-For-Performance have the potential to reduce costs and improve quality of care. Ideally, outcome indicators are used in the assessment of providers' performance. The aim of this paper is to describe the feasibility of assessing and comparing the performances of providers using a comprehensive set of quality and cost data. We had access to unique and extensive datasets containing individual data on PROMs, PREMs and costs of physiotherapy practices in Dutch primary care...
October 13, 2017: Health Policy
https://www.readbyqxmd.com/read/29051740/challenges-and-perspectives-in-bridging-in-and-outpatient-sectors-the-implementation-of-two-alternative-models-of-care-and-their-effect-on-the-average-length-of-stay
#17
Alexandre Wullschleger, Werner Wosniok, Jürgen Timm, Martin Heinze
New models of care aimed at reinforcing the outpatient sector have been introduced in Germany over the last few years. Initially, a subscription-based model ("integrated care") was introduced in 2012 in the Immanuel Klinik Rüdersdorf, wherein patients had to actively subscribe to the integrated care program. This integrated care model was replaced after 2 years by a subscription-free "model project," in which all patients insured by the contracting insurance company took part in the program. Data showed that the introduction of the integrated care program in the inpatient setting led to an increase of the average length of stay in this group...
2017: Frontiers in Psychiatry
https://www.readbyqxmd.com/read/29033595/drug-tendering-drug-supply-and-shortage-implications-for-the-uptake-of-biosimilars
#18
REVIEW
George Dranitsaris, Ira Jacobs, Carol Kirchhoff, Robert Popovian, Lesley G Shane
Due to the continued increase in global spending on health care, payers have introduced a number of programs, policies, and agreements on pharmaceutical pricing in order to control costs. While incentives to increase generic drug use have achieved significant savings, other cost-containment measures are required. Tendering is a formal procedure to purchase medications using competitive bidding for a particular contract. Although useful for cost containment, tendering can lead to decreased competition in a given market...
2017: ClinicoEconomics and Outcomes Research: CEOR
https://www.readbyqxmd.com/read/28963077/payment-and-care-for-hematopoietic-cell-transplantation-patients-toward-a-specialized-medical-home-for-complex-care-patients
#19
James L Gajewski, Mark B McClellan, Navneet S Majhail, Parameswaran N Hari, Christopher N Bredeson, Richard T Maziarz, Charles F LeMaistre, Michael C Lill, Stephanie H Farnia, Krishna V Komanduri, Michael J Boo
Patient-centered medical home models are fundamental to the advanced alternative payment models defined in the Medicare Access and Children's Health Insurance Plan Reauthorization Act (MACRA). The patient-centered medical home is a model of healthcare delivery supported by alternative payment mechanisms and designed to promote coordinated medical care that is simultaneously patient-centric and population-oriented. This transformative care model requires shifting reimbursement to include a per-patient payment intended to cover services not previously reimbursed such as disease management over time...
September 28, 2017: Biology of Blood and Marrow Transplantation
https://www.readbyqxmd.com/read/28961577/predictors-of-no-show-rate-in-the-gi-endoscopy-suite-at-a-safety-net-academic-medical-center
#20
Asim Shuja, Ciel Harris, Petra Aldridge, Miguel Malespin, Silvio W de Melo
BACKGROUND/OBJECTIVES: Noncompliance with physician and procedure appointments is associated with poor disease control and worse disease outcomes. This also impacts the quality of care, decreases efficiency, and affects revenue. Studies have shown that no-show rates are higher in clinics caring for underserved populations and may contribute to poorer health outcomes in this group. METHODS: We performed a 17-month retrospective observational cohort study of patients scheduled for outpatient procedures in the Gastroenterology endoscopy suite at the University of Florida Health, Jacksonville...
September 28, 2017: Journal of Clinical Gastroenterology
keyword
keyword
119120
1
2
Fetch more papers »
Fetching more papers... Fetching...
Read by QxMD. Sign in or create an account to discover new knowledge that matter to you.
Remove bar
Read by QxMD icon Read
×

Search Tips

Use Boolean operators: AND/OR

diabetic AND foot
diabetes OR diabetic

Exclude a word using the 'minus' sign

Virchow -triad

Use Parentheses

water AND (cup OR glass)

Add an asterisk (*) at end of a word to include word stems

Neuro* will search for Neurology, Neuroscientist, Neurological, and so on

Use quotes to search for an exact phrase

"primary prevention of cancer"
(heart or cardiac or cardio*) AND arrest -"American Heart Association"