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Plan Members (plan + member)
Kinds of Plan Members Selected AbstractsHealthcare Cost Differences with Participation in a Community-Based Group Physical Activity Benefit for Medicare Managed Care Health Plan MembersJOURNAL OF AMERICAN GERIATRICS SOCIETY, Issue 8 2008Ronald T. Ackermann MD OBJECTIVES: To determine whether participation in a physical activity benefit by Medicare managed care enrollees is associated with lower healthcare utilization and costs. DESIGN: Retrospective cohort study. SETTING: Medicare managed care. PARTICIPANTS: A cohort of 1,188 older adult health maintenance organization enrollees who participated at least once in the EnhanceFitness (EF) physical activity benefit and a matched group of enrollees who never used the program. MEASUREMENTS: Healthcare costs and utilization were estimated. Ordinary least squares regression was used, adjusting for demographics, comorbidity, indicators of preventive service use, and baseline utilization or cost. Robustness of findings was tested in sensitivity analyses involving continuous propensity score adjustment and generalized linear models with nonconstant variance assumptions. RESULTS: EF participants had similar total healthcare costs during Year 1 of the program, but during Year 2, adjusted total costs were $1,186 lower (P=.005) than for non-EF users. Differences were partially attributable to lower inpatient costs (,$3,384; P=.02), which did not result from high-cost outliers. Enrollees who attended EF an average of one visit or more per week had lower adjusted total healthcare costs in Year 1 (,$1,929; P<.001) and Year 2 (,$1,784; P<.001) than nonusers. CONCLUSION: Health plan coverage of a preventive physical activity benefit for seniors is a promising strategy to avoid significant healthcare costs in the short term. [source] Pension Valuation Under Uncertainties: Implementation of a Stochastic and Dynamic Monitoring SystemJOURNAL OF RISK AND INSURANCE, Issue 2 2002Shih-Chieh Chang Financial soundness and funding stability are two critical issues in pension fund management. First, we construct a generalized stochastic model to monitor the solvency risk and cash flow dynamics of the defined benefit pension plan. A semi-Markov process proposed by Dominicis et al. (1991) and Janssen and Manca (1997) is employed in structuring the transition pattern of the plan's population, and the economic-based factors are generated through plausible stochastic processes. Modifications according to classification and movements of the plan member and the plan's turnover pattern are also employed to improve its practical usefulness. Then the actuarial valuations, cash flow analyses, and workforce projection are performed and investigated. Second, we explicitly formulate the plan dynamics and implement the proposed mechanism into a risk management framework for pension management. By employing the stochastic and dynamic approach, the cost factors can be monitored throughout the valuation process. Third, we outline the procedure of implementing the proposed methodology into a monitoring system. Finally, the Taiwan Public Employees Retirement System is simplified to illustrate techniques in achieving risk management goals. [source] Individuals receiving addiction treatment: are medical costs of their family members reduced?ADDICTION, Issue 7 2010Constance Weisner ABSTRACT Aims To examine whether alcohol and other drug (AOD) treatment is related to reduced medical costs of family members. Design Using the administrative databases of a private, integrated health plan, we matched AOD treatment patients with health plan members without AOD disorders on age, gender and utilization, identifying family members of each group. Setting Kaiser Permanente Northern California. Participants Family members of abstinent and non-abstinent AOD treatment patients and control family members. Measurements We measured abstinence at 1 year post-intake and examined health care costs per member-month of family members of AOD patients and of controls through 5 years. We used generalized estimating equation methods to examine differences in average medical cost per member-month for each year, between family members of abstinent and non-abstinent AOD patients and controls. We used multilevel models to examine 4-year cost trajectories, controlling for pre-intake cost, age, gender and family size. Results AOD patients' family members had significantly higher costs and more psychiatric and medical conditions than controls in the pre-treatment year. At 2,5 years, each year family members of AOD patients abstinent at 1 year had similar average per member-month medical costs to controls (e.g. difference at year 5 = $2.63; P > 0.82), whereas costs for family members of non-abstinent patients were higher (e.g. difference at year 5 = $35.59; P = 0.06). Family members of AOD patients not abstinent at 1 year, had a trajectory of increasing medical cost (slope = $10.32; P = 0.03) relative to controls. Conclusions Successful AOD treatment is related to medical cost reductions for family members, which may be considered a proxy for their improved health. [source] Validity of the World Health Organization Adult ADHD Self-Report Scale (ASRS) Screener in a representative sample of health plan membersINTERNATIONAL JOURNAL OF METHODS IN PSYCHIATRIC RESEARCH, Issue 2 2007Ronald C. Kessler Abstract The validity of the six-question World Health Organization Adult ADHD Self-Report Scale (ASRS) Screener was assessed in a sample of subscribers to a large health plan in the US. A convenience subsample of 668 subscribers was administered the ASRS Screener twice to assess test-retest reliability and then a third time in conjunction with a clinical interviewer for DSM-IV adult ADHD. The data were weighted to adjust for discrepancies between the sample and the population on socio-demographics and past medical claims. Internal consistency reliability of the continuous ASRS Screener was in the range 0.63,0.72 and test-retest reliability (Pearson correlations) in the range 0.58,0.77. A four-category version The ASRS Screener had strong concordance with clinician diagnoses, with an area under the receiver operating characteristic curve (AUC) of 0.90. The brevity and ability to discriminate DSM-IV cases from non-cases make the six-question ASRS Screener attractive for use both in community epidemiological surveys and in clinical outreach and case-finding initiatives. Copyright © 2007 John Wiley & Sons, Ltd. [source] Randomized Trial to Improve Prescribing Safety in Ambulatory Elderly PatientsJOURNAL OF AMERICAN GERIATRICS SOCIETY, Issue 7 2007Marsha A. Raebel PharmD OBJECTIVES: To determine whether a computerized tool that alerted pharmacists when patients aged 65 and older were newly prescribed potentially inappropriate medications was effective in decreasing the proportion of patients dispensed these medications. DESIGN: Prospective, randomized trial. SETTING: U.S. health maintenance organization. PARTICIPANTS: All 59,680 health plan members aged 65 and older were randomized to intervention (n=29,840) or usual care (n=29,840). Pharmacists received alerts on all patients randomized to intervention who were newly prescribed a targeted medication. INTERVENTION: Prescription and age information were linked to alert pharmacists when a patient aged 65 and older was newly prescribed one of 11 medications that are potentially inappropriate in older people. MEASUREMENTS: Physicians and pharmacists collaborated to develop the targeted medication list, indications for medication use for which an intervention should occur, intervention guidelines and scripts, and to implement the intervention. RESULTS: Over the 1-year study, 543 (1.8%) intervention group patients aged 65 and older were newly dispensed prescriptions for targeted medications, compared with 644 (2.2%) usual care group patients (P=.002). For medication use indications in which an intervention should occur, dispensings of amitriptyline (P<.001) and diazepam (P=.02) were reduced. CONCLUSIONS: This study demonstrated the effectiveness of a computerized pharmacy alert system plus collaboration between healthcare professionals in decreasing potentially inappropriate medication dispensings in elderly patients. Coupling data available from information systems with the knowledge and skills of physicians and pharmacists can improve prescribing safety in patients aged 65 and older. [source] Frequency of high-risk use of QT-prolonging medications,PHARMACOEPIDEMIOLOGY AND DRUG SAFETY, Issue 6 2006Nancy M. Allen LaPointe PharmD Abstract Purpose Prolongation of the QT interval has been associated with increased risk of torsades de pointes and death. Concurrent use of more than one QT-prolonging drug or a QT-prolonging drug with a drug that alters its pharmacokinetic profile is an important risk factor for adverse outcomes. Methods Using a representative sample of 2 million health plan members from 10 health maintenance organizations with pharmacy benefits between January 1999 and July 2001, we identified potential drug interactions involving QT-prolonging medications. Prescription claims overlapping by at least 7 days for either 2 or more QT-prolonging drugs or a QT-prolonging drug with a drug that alters its clearance were considered potential drug interactions. We determined the number of drug interactions overall and the number of these interactions involving patients with other risk factors for torsades de pointes. Results A total of 48,465 potential drug interactions were identified in 10,415 (4.6%) of the 228,550 patients with at least one prescription for a QT-prolonging drug. Amitriptyline was involved in 37,859 (78.1%) of the drug interactions. Of all potential drug interactions, 43,689 (90.1%) occurred in patients with at least one other risk factor for torsades de pointes, and 1053 (2.2%) were listed as a contraindicated combination in product labeling. Conclusion Potential drug interactions involving currently marketed QT-prolonging drugs occurred in 4.6% of patients who had a prescription for a QT-prolonging medication. The findings suggest several areas for targeted interventions to decrease the potential risk from QT-prolonging medications. Copyright © 2005 John Wiley & Sons, Ltd. [source] Efficiency and Economic Benefits of a Payer-based Electronic Health Record in an Emergency DepartmentACADEMIC EMERGENCY MEDICINE, Issue 8 2010Gregory W. Daniel PhD ACADEMIC EMERGENCY MEDICINE 2010; 17:824,833 © 2010 by the Society for Academic Emergency Medicine Abstract Objectives:, The objective was to evaluate the use of a payer-based electronic health record (P-EHR), which is a clinical summary of a patient's medical and pharmacy claims history, in an emergency department (ED) on length of stay (LOS) and plan payments. Methods:, A large urban ED partnered with the dominant health plan in the region and implemented P-EHR technology in September 2005 for widespread use for health plan members presenting to the ED. A retrospective observational study design was used to evaluate this previously implemented P-EHR. Health plan and electronic hospital data were used to identify 2,288 ED encounters. Encounters with P-EHR use (n = 779) were identified between September 1, 2005, and February 17, 2006; encounters from the same health plan (n = 1,509) between November 1, 2004, and March 31, 2005, were compared. Outcomes were ED LOS and plan payment for the ED encounter. Analyses evaluated the effect of using the P-EHR in the ED setting on study outcomes using multivariate regressions and the nonparametric bootstrap. Results:, After covariate adjustment, among visits resulting in discharge (ED-only), P-EHR visits were 19 minutes shorter (95% confidence interval [CI] = 5 to 33 minutes) than non-P-EHR visits. Among visits resulting in hospitalization, the P-EHR was associated with an average 77-minute shorter ED LOS (95% CI = 28 to 126 minutes), compared to non,P-EHR visits. The P-EHR was associated with an average of $1,560 (95% CI = $43 to $2,910) lower total plan expenditures for hospitalized visits. No significant difference in total payments was observed among discharged visits. Conclusions:, In the study ED, the P-EHR was associated with a significant reduction in ED LOS overall and was associated with lower plan payments for visits that resulted in hospitalization. [source] | ||||||||||