Providers

Institution of paperless credentialing is analyzed on a pre-/post-implementation basis to understand the impact on business and productivity.

This study examines variation among health plans in resource use and quality of care for patients with diabetes mellitus or cardiovascular disease.

Health plan accounting data are used to test how well the CMSHCC risk adjustment system tracks relative costs of treating various diagnoses: not very well.

Three approaches to prospective patient identification for care management programs were compared: predictive modeling, selection by primary care physician, and a combination of both.

Economic evaluations of adjuvant trastuzumab were reviewed. Three primary shortcomings were identified including incorporation of local data and estimation and representation (visual) of decision uncertainty.

India's emerging health insurance sector faces significant operational challenges that managed care models can help to address.

There is a critical need for comparative information about plan resource use to support value-based purchasing efforts.