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Pesquisa : N03.219.521.576.343.800.875 [Categoria DeCS]
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[PMID]:28199284
[Au] Autor:Jacobson CA
[Ad] Endereço:Catherine A. Jacobson is president and CEO of Froedtert Health, a regional healthcare system based in Milwaukee, Wisconsin, and affiliated with the Medical College of Wisconsin. She also serves as board chair of Integrated Health Network of Wisconsin and of Network Health.
[Ti] Título:Provider-Sponsored Health Plans: A Tool for Moving Toward Value-Based Reimbursement.
[So] Source:Front Health Serv Manage;33(1):40-46, 2016.
[Is] ISSN:0748-8157
[Cp] País de publicação:United States
[La] Idioma:eng
[Mh] Termos MeSH primário: Planejamento em Saúde
Organizações Patrocinadas pelo Prestador
Mecanismo de Reembolso
[Mh] Termos MeSH secundário: Seres Humanos
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Em] Mês de entrada:1709
[Cu] Atualização por classe:170906
[Lr] Data última revisão:
170906
[Sb] Subgrupo de revista:H
[Da] Data de entrada para processamento:170216
[St] Status:MEDLINE


  2 / 175 MEDLINE  
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[PMID]:28199282
[Au] Autor:Peterson MD
[Ad] Endereço:Mary Dale Peterson, MD, FACHE, is president and CEO of Driscoll Health Plan based in Corpus Christi, Texas.
[Ti] Título:Provider-Sponsored Health Plans: Are They Right for You?
[So] Source:Front Health Serv Manage;33(1):27-32, 2016.
[Is] ISSN:0748-8157
[Cp] País de publicação:United States
[La] Idioma:eng
[Mh] Termos MeSH primário: Planejamento em Saúde
Organizações Patrocinadas pelo Prestador
[Mh] Termos MeSH secundário: Seres Humanos
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Em] Mês de entrada:1709
[Cu] Atualização por classe:170906
[Lr] Data última revisão:
170906
[Sb] Subgrupo de revista:H
[Da] Data de entrada para processamento:170216
[St] Status:MEDLINE


  3 / 175 MEDLINE  
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[PMID]:28199281
[Au] Autor:Johnson SP
[Ad] Endereço:Steven P. Johnson, PhD, is president and CEO of Health First, a fully integrated health system based in Rockledge, Florida.
[Ti] Título:The Role of a Provider-Sponsored Health Plan in Achieving Scale and Integration.
[So] Source:Front Health Serv Manage;33(1):16-26, 2016.
[Is] ISSN:0748-8157
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:In pursuit of two primary strategies-to become an integrated delivery network (IDN) on the local level and to achieve additional overall organizational scale to sustain operations-Health First, based in Rockledge, Florida, relies on the success of its provider-sponsored health plan (PSHP) as a critical asset. For Health First, the PSHP serves as an agent for holding and administering financial risk for the health of populations. In addition, we are learning that our PSHP is a critical asset in support of integrating the components of our care delivery system to manage that financial risk effectively, efficiently, and in a manner that creates a unified experience for the customer.Health First is challenged by continuing pressure on reimbursement, as well as by a substantial regulatory burden, as we work to optimize the environments and tools of care and population health management. Even with strong margins and a healthy balance sheet, we simply do not have the resources needed to bring an IDN robustly to life. However, we have discovered that our PSHP can be the vehicle that carries us to additional scale. Many health systems do not own or otherwise have access to a PSHP to hold and manage financial risk. Health First sought and found a not-for-profit health system with complementary goals and a strong brand to partner with, and we now provide private-label health plan products for that system using its strong name while operating the insurance functions under our license and with our capabilities.
[Mh] Termos MeSH primário: Prestação Integrada de Cuidados de Saúde
Planejamento em Saúde
Organizações Patrocinadas pelo Prestador
[Mh] Termos MeSH secundário: Florida
Sistemas Pré-Pagos de Saúde
Seres Humanos
Organizações sem Fins Lucrativos
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Em] Mês de entrada:1709
[Cu] Atualização por classe:170906
[Lr] Data última revisão:
170906
[Sb] Subgrupo de revista:H
[Da] Data de entrada para processamento:170216
[St] Status:MEDLINE


  4 / 175 MEDLINE  
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[PMID]:26189215
[Au] Autor:McCue MJ
[Ti] Título:Assessing the Financial Condition of Provider-Sponsored Health Plans.
[So] Source:Manag Care;24(6):39-44, 2015 Jun.
[Is] ISSN:1062-3388
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:PURPOSE: The aim of this study was to assess the performance of health plans sponsored by provider organizations, with respect to plans generating strong positive cash flow relative to plans generating weaker cash flow. A secondary aim was to assess their capital adequacy. DESIGN: The study identified 24 provider-sponsored health plans (PSHPs) with an average positive cash flow margin from 2011 through 2013 at or above the top 75th percentile, defined as "strong cash flow PSHPs:" This group was compared with 72 PSHPs below the 75th percentile, defined as "weak cash flow PSHPs:" METHODOLOGY: Atlantic Information Services Directory of Health Plans was used to identify the PSHPs. Financial ratios were computed from 2013 National Association of Insurance Commissioners Financial Filings. The study conducted a t test mean comparison between strong and weak cash flow PSHPs across an array of financial performance and capital adequacy measures. RESULTS: In 2013, the strong cash flow PSHPs averaged a cash-flow margin ratio of 6.6%. Weak cash flow PSHPs averaged a cash-flow margin of -0.4%. The net worth capital position of both groups was more than 4.5 times authorized capital. CONCLUSION: The operational analysis shows that strong cash-flow margin PSHPs are managing their medical costs to achieve this position. Although their medical loss ratio increased by almost 300 basis points from 2011 to 2013, it was still statistically significantly lower than the weaker cash flow PSHP group (P<.001). In terms of capital adequacy, both strong and weak cash-flow margin PSHP groups possessed sufficient capital to ensure the viability of these plans.
[Mh] Termos MeSH primário: Eficiência Organizacional/economia
Organizações Patrocinadas pelo Prestador/economia
[Mh] Termos MeSH secundário: Bases de Dados Factuais
Organizações Patrocinadas pelo Prestador/organização & administração
Estados Unidos
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Em] Mês de entrada:1508
[Cu] Atualização por classe:150717
[Lr] Data última revisão:
150717
[Sb] Subgrupo de revista:H
[Da] Data de entrada para processamento:150721
[St] Status:MEDLINE


  5 / 175 MEDLINE  
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[PMID]:25318267
[Au] Autor:Demko P
[Ti] Título:Exchange battle. Provider-sponsored plans price more aggressively to catch up with insurers.
[So] Source:Mod Healthc;44(34):30-1, 2014 Aug 25.
[Is] ISSN:0160-7480
[Cp] País de publicação:United States
[La] Idioma:eng
[Mh] Termos MeSH primário: Competição Econômica
Trocas de Seguro de Saúde
Cobertura do Seguro/economia
Organizações Patrocinadas pelo Prestador/economia
[Mh] Termos MeSH secundário: Patient Protection and Affordable Care Act
Estados Unidos
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Em] Mês de entrada:1412
[Cu] Atualização por classe:141016
[Lr] Data última revisão:
141016
[Sb] Subgrupo de revista:H
[Da] Data de entrada para processamento:141017
[St] Status:MEDLINE


  6 / 175 MEDLINE  
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[PMID]:24850110
[Au] Autor:Grider JS; Findley KA; Higdon C; Curtright J; Clark DP
[Ad] Endereço:University of Kentucky, Lexington, KY; Indiana University Health, Indianapolis, IN;3University of Tennessee Haslam College of Business, Knoxville, TN.
[Ti] Título:Economic impact of converting an interventional pain medicine physician office-based practice into a provider-based ambulatory pain practice.
[So] Source:Pain Physician;17(3):E253-61, 2014 May-Jun.
[Is] ISSN:2150-1149
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:BACKGROUND: One consequence of the shifting economic health care landscape is the growing trend of physician employment and practice acquisition by hospitals. These acquired practices are often converted into hospital- or provider-based clinics. This designation brings the increased services of the hospital, the accreditation of the hospital, and a new billing structure verses the private clinic (the combination of the facility and professional fee billing). One potential concern with moving to a provider-based designation is that this new structure might make the practice less competitive in a marketplace that may still be dominated by private physician office-based practices. The aim of the current study was to evaluate the impact of the provider-based/hospital fee structure on clinical volume. OBJECTIVE: Determine the effect of transition to a hospital- or provider-based practice setting (with concomitant cost implications) on patient volume in the current practice milieu. SETTING:   Community hospital-based academic interventional pain medicine practice. STUDY DESIGN: Economic analysis of effect of change in price structure on clinical volumes. METHODS: The current study evaluates the effect of a change in designation with price implications on the demand for clinical services that accompany the transition to a hospital-based practice setting from a physician office setting in an academic community hospital. RESULTS: Clinical volumes of both procedures and clinic volumes increased in a mature practice setting following transition to a provider-based designation and the accompanying facility and professional fee structure. Following transition to a provider-based designation clinic visits were increased 24% while procedural volume demand did not change. LIMITATIONS: Single practice entity and single geographic location in southeastern United States. CONCLUSIONS: The conversion to a hospital- or provider-based setting does not negatively impact clinical volume and referrals to community-based pain medicine practice. These results imply that factors other than price are a driver of patient choice.  
[Mh] Termos MeSH primário: Instituições de Assistência Ambulatorial/economia
Manejo da Dor/economia
Consultórios Médicos/economia
Médicos/economia
Organizações Patrocinadas pelo Prestador/economia
[Mh] Termos MeSH secundário: Instituições de Assistência Ambulatorial/tendências
Seres Humanos
Reembolso de Seguro de Saúde/economia
Reembolso de Seguro de Saúde/tendências
Dor/economia
Manejo da Dor/tendências
Médicos/tendências
Consultórios Médicos/tendências
Organizações Patrocinadas pelo Prestador/tendências
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Em] Mês de entrada:1506
[Cu] Atualização por classe:140522
[Lr] Data última revisão:
140522
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:140523
[St] Status:MEDLINE


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Texto completo
[PMID]:24841883
[Au] Autor:Ginsburg PB; Pawlson LG
[Ad] Endereço:Paul B. Ginsburg (paul.ginsburg@usc.edu) is the Norman Topping/National Medical Enterprises Chair in Medicine and Public Policy at the Sol Price School of Public Policy and the Leonard D. Schaeffer Center for Health Policy and Economics, University of Southern California, in Los Angeles.
[Ti] Título:Seeking lower prices where providers are consolidated: an examination of market and policy strategies.
[So] Source:Health Aff (Millwood);33(6):1067-75, 2014 Jun.
[Is] ISSN:1544-5208
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:The ongoing consolidation between and among hospitals and physicians tends to raise prices for health care services, which poses increasing challenges for private purchasers and payers. This article examines strategies that these purchasers and payers can pursue to combat provider leverage to increase prices. It also examines opportunities for governments to either support or constrain these strategies. In response to higher prices, payers are developing new approaches to benefit and network design, some of which may be effective in moderating prices and, in some cases, volume. These approaches interact with public policy because regulation can either facilitate or constrain them. Federal and state governments also have opportunities to limit consolidation's effect on prices by developing antitrust policies that better address current market environments and by fostering the development of physician organizations that can increase competition and contract with payers under shared-savings approaches. The success of these private- and public-sector initiatives likely will determine whether governments shift from supporting competition to directly regulating payment rates.
[Mh] Termos MeSH primário: Comércio
Assistência à Saúde/economia
Compras em Grupo/economia
Convênios Médico-Hospitalares/economia
Marketing de Serviços de Saúde/economia
Patient Protection and Affordable Care Act/economia
[Mh] Termos MeSH secundário: Leis Antitruste/economia
Controle de Custos/economia
Controle de Custos/legislação & jurisprudência
Assistência à Saúde/legislação & jurisprudência
Competição Econômica
Compras em Grupo/legislação & jurisprudência
Convênios Médico-Hospitalares/legislação & jurisprudência
Seres Humanos
Reembolso de Seguro de Saúde/economia
Reembolso de Seguro de Saúde/legislação & jurisprudência
Marketing de Serviços de Saúde/legislação & jurisprudência
Patient Protection and Affordable Care Act/legislação & jurisprudência
Organizações Patrocinadas pelo Prestador/economia
Organizações Patrocinadas pelo Prestador/legislação & jurisprudência
Estados Unidos
[Pt] Tipo de publicação:JOURNAL ARTICLE; RESEARCH SUPPORT, NON-U.S. GOV'T
[Em] Mês de entrada:1510
[Cu] Atualização por classe:160908
[Lr] Data última revisão:
160908
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:140521
[St] Status:MEDLINE
[do] DOI:10.1377/hlthaff.2013.0810


  8 / 175 MEDLINE  
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[PMID]:23947253
[Au] Autor:Evans M
[Ti] Título:Cutting out the middleman. Systems buying and developing insurance plans.
[So] Source:Mod Healthc;43(12):10-1, 2013 Mar 25.
[Is] ISSN:0160-7480
[Cp] País de publicação:United States
[La] Idioma:eng
[Mh] Termos MeSH primário: Planos de Assistência de Saúde para Empregados/economia
Sistemas Multi-Institucionais/economia
Organizações Patrocinadas pelo Prestador/economia
[Mh] Termos MeSH secundário: Planos de Assistência de Saúde para Empregados/organização & administração
Planos de Assistência de Saúde para Empregados/tendências
Seres Humanos
Cobertura do Seguro
Sistemas Multi-Institucionais/organização & administração
Sistemas Multi-Institucionais/tendências
Organizações Patrocinadas pelo Prestador/organização & administração
Organizações Patrocinadas pelo Prestador/tendências
Estados Unidos
[Pt] Tipo de publicação:NEWS
[Em] Mês de entrada:1309
[Cu] Atualização por classe:130816
[Lr] Data última revisão:
130816
[Sb] Subgrupo de revista:H
[Da] Data de entrada para processamento:130817
[St] Status:MEDLINE


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[PMID]:23461428
[Au] Autor:Liberman JN; Lichtenfeld MJ; Galaznik A; Mastey V; Harnett J; Zou KH; Leader JB; Kirchner HL
[Ad] Endereço:Research Operations, Geisinger Clinic Center for Health Research, Danville, PA, USA. libermjn@sutterhealth.org
[Ti] Título:Adherence to varenicline and associated smoking cessation in a community-based patient setting.
[So] Source:J Manag Care Pharm;19(2):125-31, 2013 Mar.
[Is] ISSN:1944-706X
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:BACKGROUND: Varenicline, a selective α4ß2 nicotinic acetylcholine receptor partial agonist, is a pharmacotherapy indicated for smoking cessation treatment. To our knowledge, no studies have described varenicline treatment adherence and efficacy from real-world treatment patterns in a U.S. primary care setting. OBJECTIVE: To estimate adherence to varenicline prescription orders and subsequent quit rates among smokers in a primary care setting. METHODS: In this retrospective cohort study, eligible patients were enrolled with Geisinger Health Plan, had an initial varenicline prescription written by a Geisinger provider between January 1, 2006, and December 31, 2009, and had a follow-up clinic visit within the subsequent 12 months. Adherence was derived from linking electronic prescriptions with adjudicated pharmacy claims. Smoking status was collected at each health care encounter. RESULTS: Of the 1,477 eligible patients, 823 (55.7%) were primary nonadherent, having failed to initiate on the prescribed varenicline therapy. Of the remaining 654 patients, 359 (54.9%) were adherent, having completed a full 12-week course of therapy, and 295 (45.1%) were partially adherent, having initiated but not completed the full course of therapy. A total of 521 patients (35.3%) ceased smoking during the 12-month follow-up period: 182 (50.7%) of the adherent cohort, 82 (27.8%) of the partially adherent population, and 257 (31.2%) of the nonadherent cohort. No significant difference was found in quit rates between the partially adherent and nonadherent patient cohorts (adjusted HR 0.88 [95% CI=0.69-1.13]). However, patients adherent to the varenicline regimen were almost twice as likely to succeed in quitting smoking compared with completely nonadherent patients (HR 1.93 [95% CI=1.59-2.33]). CONCLUSION: Smoking cessation occurred more often among individuals adherent to varenicline therapy; however, medication nonadherence was common. After prescribing varenicline, clinicians and payers could consider active patient follow-up to maximize adherence and optimize treatment outcomes.
[Mh] Termos MeSH primário: Benzazepinas/uso terapêutico
Centros Comunitários de Saúde
Agonistas Nicotínicos/uso terapêutico
Cooperação do Paciente
Atenção Primária à Saúde
Quinoxalinas/uso terapêutico
Abandono do Hábito de Fumar
Tabagismo/tratamento farmacológico
[Mh] Termos MeSH secundário: Adulto
Estudos de Coortes
Registros Eletrônicos de Saúde
Feminino
Seguimentos
Seres Humanos
Masculino
Meia-Idade
Pennsylvania
Organizações Patrocinadas pelo Prestador
Estudos Retrospectivos
Autorrelato
Recusa do Paciente ao Tratamento
Vareniclina
[Pt] Tipo de publicação:JOURNAL ARTICLE; RESEARCH SUPPORT, NON-U.S. GOV'T
[Nm] Nome de substância:
0 (Benzazepines); 0 (Nicotinic Agonists); 0 (Quinoxalines); W6HS99O8ZO (Varenicline)
[Em] Mês de entrada:1308
[Cu] Atualização por classe:151119
[Lr] Data última revisão:
151119
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:130307
[St] Status:MEDLINE


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[PMID]:23088055
[Au] Autor:Berarducci J; Langheim R; Vars A
[Ad] Endereço:Kurt Salmon, Minneapolis, USA. jim.berarducci@kurtsalmon.com
[Ti] Título:New partnership opportunities for payers and providers.
[So] Source:Healthc Financ Manage;66(10):58-61, 2012 Oct.
[Is] ISSN:0735-0732
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:Healthcare finance executives should consider several key factors when forming partnerships with physicians and insurers: Market expansion opportunities. Resources. Risk sharing. Capturing created value. Market response.
[Mh] Termos MeSH primário: Administração Financeira de Hospitais
Reestruturação Hospitalar
Sistemas Multi-Institucionais/organização & administração
Afiliação Institucional
[Mh] Termos MeSH secundário: Organizações de Assistência Responsáveis/organização & administração
Seres Humanos
Seguradoras
Organizações Patrocinadas pelo Prestador/organização & administração
Estados Unidos
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Em] Mês de entrada:1211
[Cu] Atualização por classe:121023
[Lr] Data última revisão:
121023
[Sb] Subgrupo de revista:H
[Da] Data de entrada para processamento:121024
[St] Status:MEDLINE



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