Strategies for strengthening the evidence base for employee health promotion programs.

Employee health promotion programs have been a visible facet of the American workplace for more than 30 years. During that time, a substantial amount of research on best practices has been conducted, but because of a lack of significant public investment in research funding there is still much to be done. Most researchers and practitioners familiar with the literature recognize the need to strengthen the evidence base for the field.

Health insurers promoting employee wellness: strategies, program components and results.

Purpose: To examine health insurance companies' role in employee wellness.

Approach: Case studies of eight insurers.

Setting: Wellness activities in work, clinical, online, and telephonic settings.

Understanding and enhancing the value of hospital discharge data.

This work summarizes how hospital discharge data are used, identifies strengths and shortcomings, and presents suggestions for enhancing usefulness of the data. Results demonstrate that discharge data are used in a wide range of applications by diverse users. Uses include public health and population-based applications, as well as quality assessment, informed purchasing, strategic planning, and policy making.

Health care use and expenditures of Medicare HMO disenrollees.

We examine the impact of the first wave of Medicare health maintenance organization HMO withdrawals. With data from CMS and United Health Group, we estimate use and expenditure changes between 1998 and 1999 for HMO enrollees who were involuntarily dropped from their plan and returned to fee-for-service (FFS) Medicare using a difference-in-difference model. Compared to those who voluntarily left an HMO, involuntarily disenrolled beneficiaries had higher out-of-pocket expenditures, an 80 percent decrease in physician visits, 38 percent higher emergency room (ER) use and a higher probability of dying.

Impact of HMO withdrawals on vulnerable Medicare beneficiaries.

The Medicare+Choice (M+C) program has faced successive waves of plan withdrawals since 1999. We collected data from 1,055 beneficiaries who were involuntarily disenrolled from a health maintenance organization (HMO) that withdrew from six large markets in 1999 to investigate how they were impacted by the forced change in coverage. Administrative data from this HMO were used to oversample beneficiaries who were perceived to be vulnerable based on their poor health status in the period before the HMO withdrawal.

Rural implications of Medicare's post-acute-care transfer payment policy.

Context: Under the Medicare post-acute-care (PAC) transfer policy, acute-care hospitals are reimbursed under a per-diem formula whenever beneficiaries are discharged from selected diagnosis-related groups (DRGs) to a skilled nursing facility, home health care, or a prospective payment system (PPS)-excluded facility. Total per-diem payments are below the full DRG payment only when the patient's length of stay (LOS) is short relative to the geometric mean LOS for the DRG; otherwise, the full DRG payment is received. This policy originally applied to 10 DRGs beginning in fiscal year 1999 and was expanded to additional DRGs in FY2004.

Impact of differential response rates on the quality of data collected in the CTS physician survey.

Survey administrators face trade-offs between expending additional survey resources to maximize response rates versus using fewer resources and accepting lower response rates. Using data from the Community Tracking Study's Physician Survey, we examined how survey estimates and data quality changed as additional respondents completed the survey. Results showed that improvements in response rates over the range examined (i.

Do hospital-based rural health clinics improve the performance of the parent hospital?

This study shows that establishing an RHC may lead to beneficial impacts for the parent hospital, and that these benefits have been experienced by categories of hospitals that are now subject to the new limit on RHC reimbursement legislated by the Balanced Budget Act.

Medicare physician payment changes: impact on physicians and beneficiaries.

The Balanced Budget Act (BBA) of 1997 generally reduced Medicare payments for surgical services while increasing them for other services. Concern about implications of these fee reductions prompted the Medicare Payment Advisory Commission to sponsor a national survey of physicians to learn their views on Medicare payment and whether access to care has changed for Medicare beneficiaries. Results suggest that beneficiaries' access to care has not declined.

Impact of the BBA on Medicare HMO payments for rural areas.

The Balanced Budget Act (BBA) of 1997 radically changed the way Medicare risk plans are paid, replacing the adjusted average per capita cost (AAPCC) system with one in which county payment rates are set as the highest of (1) a local/national blended rate; (2) a national payment floor; or (3) a 2 percent minimum update from the prior year's rate. This DataWatch presents results of simulations of the likely impact of these changes throughout the BBA implementation period ending in 2003. The assessment considers urban/rural differences in payment levels, year-to-year rate volatility, the types of rates paid, and budget-neutrality issues.

Primary care case management for Medicaid recipients: evaluation of the Maryland Access to Care program.

A growing number of states are implementing Medicaid managed care programs, and primary care case management (PCCM) is an important component of many of these systems. In this paper, we present results of an evaluation of one such PCCM program--the Maryland Access to Care (MAC) program. The evaluation uses five years of Medicaid claims and eligibility data from the period before and after the program's introduction to determine the program's impact on expenditures and service utilization.

Description of the US working age disabled populations living in institutions and in the community.

This study provides national estimates of the size of the US working age disabled populations in institutions and in the community, and describes these populations along a number of dimensions. By using data from the Institutional Population and Household Survey Components of the 1987 National Medical Expenditure Survey, the study represents the first time that these populations have been studied using comparable data. The working age disabled population was identified as persons between the ages of 21 and 64 who experienced difficulty with at least one of the activities of daily living (ADLs).

Improving payments for Medicare patients with unrelated surgical procedures.

The Medicare prospective payment system (PPS) pays hospitals a fixed payment for patients in 474 categories of diagnosis-related groups (DRGs). Since the beginning of PPS, many DRGs have been modified to improve the accuracy of patient classification and the equity of hospital payments. There are continuing problems, however, in classifying surgical patients who have no procedure related to their reason for admission.