Managed Care for Elderly People: A Compendium of Findings

Although managed care seems to serve well the in terests of non-elderly enrollees and their payers, elderly people face more risks. Chronic conditions, multiple prob lems, and more limited resources make them more vul nerable, whereas multiple payer sources make them more complicated to cover. This synthesis of managed care de livered in Medicare and Medicaid demonstration projects serving elderly beneficiaries shows that managed care plans either select or attract enrollees who suffer fewer frailties than those served in fee-for-service settings, ex hibit reluctance to enter rural markets, provide a broad range of elderly-specific services, offer more compre hensive coverage and services, and result in greater per ceived access problems, particularly for vulnerable subgroups. Plans operate more cheaply by using fewer resources, even after adjusting for case mix differences. Managed care enrollees tend to be more satisfied with financial and coverage aspects, whereas fee-for-service enrollees report higher satisfaction on other dimensions. In acute care settings, process of care findings were mixed, whereas clinical and self-reported outcome indi cators were no better and in some instances worse in managed care. Long-term care enrollees, in the few stud ies reported, consistently faired worse in both the processes and outcomes of care. These findings suggest that further research on the effects of managed care in its rapidly changing incarnations is needed, particularly with respect to how to improve the quality of acute and long-term care delivered to elderly people and the proper role of government and other key actors in the health care system.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/66514/2/10.1177_106286069801300304.pd

Survival Skills for the Political Environment of Health Insurance

Blue Cross Blue Shield of Michigan asked the Michigan state government for small group market rate reform already adopted in most other states. Officials responded with major restructuring proposals aimed specifically at the Blues. The Michigan Blues fought back with a massive lobbying campaign as vigorous as any mounted by opponents of health reform at the national level. The company was able to prevail over one of the most powerful governors in Michigan history, whose party controlled both houses of the legislature. This amazing political victory shared much in common with the Clinton health reform's defeat by the industry and the more recent success of the prescription drug industry in shaping Medicare prescription drug reform to its liking. The experience suggests that political savvy and lobbying skills have become core competencies in the health care industry

A Model for Reducing the Cost of Care in VA Medical Centers that Offer Adult Day Health Care

One approach to providing cost-effective adult day health care (ADHC) services is to guide both the inputs to ADHC services and the provision of other services so that substitution for institutional services can realistically take place. This approach has been used in a randomized clinical trial to evaluate the medical efficacy and cost of ADHC in the Department of Veterans Affairs (DVA). This article describes the strategies that were used to improve the cost effectiveness of ADHC during the evaluation. Cost and use estimates were developed based on the best data available from the DVA and previous research on the cost for patients' use of ADHC, nursing home, hospital, and ambulatory care. A cost workshop was attended by the ADHC managers to develop plans for controlling costs. Plans were identified that increase the likelihood that ADHC can be shown to be less costly than customary care.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/67132/2/10.1177_089826439000200405.pd

Toward a Strategy for Reducing Potentially Avoidable Hospital Admissions among Home Care Clients

Cognizant of the disappointing health status effects of home care in past studies, the authors argue that home care (homemaker, chore, day care, and other personal care services) is ill equipped to alter health status but could alter the way in which patients, family, and physicians respond to health status changes. If it does this, it should be effective in preventing some of certain types of hospitalizations: those for death, nursing home placement, and evaluation. This study, which reanalyzes the National Channeling Demonstration Project data set to focus on these three most promising outcome effects of home care found that it did not prevent these types of potentially avoidable hospitalizations. Indeed, there is little evidence that such targeted preventive efforts took place. This may suggest that the objective function of home care should be redefined to focus on altering responses to health status change rather than on altering health status.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/68339/2/10.1177_107755879705400403.pd