Although health maintenance organization (HMO) structures and databases are not uniform across plans, there are unique characteristics of HMO data in general that make them useful in examining health policy and delivery issues. The authors examine differences in data generated by different types of HMOs. After discussing why health services research using HMO data is needed by HMOs, other providers, practitioners, payers, and consumers of health care, the authors examine ways in which HMOs can provide sound answers to crucially important questions about the future of health care. They conclude that although the need for research on HMOs is compelling, researchers need to understand the information needs of HMOs and the incentives that are shaping the industry's approach to system delivery and clinical outcomes research. If HMOs do not take the lead in conducting health services research, they will diminish their role in shaping policies that will shape their future evolution.
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References
1.
Alan Guttmacher Institute.Uneven and Unequal: Insurance Coverage and Reproductive Health Services.New York: Alan Guttmacher Institute,1994.
2.
AllenH. M., DarlingH., McNeillD. N., and BastienF.“The Employee Health Care Value Survey: Round One.”Health Affairs13 (Fall 1994): 2541.
3.
BaderB. S., and MathenyM.“Understanding Capitation and At-Risk Contracting.”Health System Leader1 (1994): 4–19.
4.
BernsteinA. B., BergstenC., WhitmoreH., DialT., and GabelJ.1994 HMO Performance Report.Washington, DC: Group Health Association of America,1994.
5.
BorbasC., McLaughlinD. B., and SchultzA.“The Minnesota Clinical Comparison and Assessment Program: Bridging the Gap between Clinical Practice Guidelines and Patient Care.” Unpublished draft, HealthCare Education and Research Foundation, 1994.
6.
BrodyH.“Quality and HealthCare Reform.”Journal of Family Practice39 (1994): 423–26.
7.
BrownJ. B., ShyeD., and McFarlandB.“The Paradox of Guideline Implementation: How AHCPR's Depression Guideline Was Adapted at Kaiser Permanente Northwest Region.”Journal of Quality Improvement21 (1995): 5–21.
8.
BrownR. S., ClementD. G., HillJ. W., RetchinS. M., and BergeronJ. W.“Do Health Maintenance Organizations Work for Medicare?”Health Care Financing Review15 (Fall 1993): 7–23.
9.
BurnsL. R., AndersenR. M., and ShortellS. M.“Trends in Hospital/Physician Relationships.”Health Affairs12 (1993): 213–23.
10.
CarlisleD. M., SiuA., KeelerE. B., McGlynnE. A., KahnK. L., RubensteinL. V., and BrookR. H.“HMO vs. Fee-for-Service Care of Older Persons with Acute Myocardial Infarction.”American Journal of Public Health82 (1992): 1626–30.
11.
CaveD. G.“Incentives and Cost Containment in Primary Care Physician Reimbursement.”Benefits Quarterly9 (Third Quarter 1993): 70–77.
12.
CebulR. D.“Randomized, Controlled Trials Using the Metro Firm System.”Medical Care29 (July 1991 Suppl.): JS9–18.
13.
CellaD. F., and LloydS. R.“Data Collection Strategies for Patient-Reported Information.”Quality Management in Health Care2 (Summer 1994): 28–35.
14.
Congressional Budget Office.CBO Memorandum: The Effects of Managed Care and Managed Competition.Washington, DC: Congressional Budget Office, February 1995.
15.
CooperP. P., and GreenK.“The Impact of State Laws on Managed Care.”Health Affairs10 (1991): 161–69.
16.
DarlingH.“Employers and Managed Care: What Are the Early Returns?”Health Affairs10 (1991): 148–60.
17.
DullV. T., LanskyD., and DavisN.“Evaluating a Patient Satisfaction Survey for Maximum Benefit.”Joint Commission Journal on Quality Improvement20 (1994): 444–52.
18.
FreundD. A., and HurleyR. E.“Medicaid Managed Care: Contributions to Issues of Health Reform.”Annual Review of Public Health16 (1995): 473–95.
19.
GausC. R.“Promoting Quality and Accountability through Public-Private Partnerships.” Presented to the Health Care Quality Alliance, Washington, DC, February 14, 1995.
20.
GoldM., and WooldridgeJ.“Surveying Consumer Satisfaction to Assess Managed-Care Quality: Current Practices.”Health Care Financing Review16 (4, 1995): 155–73.
21.
Group Health Association of America.HMO Industry Profile, 1994 ed.Washington, DC: GHAA, 1994.
22.
Group Health Association of America.1995 National Directory of HMOs.Washington, DC: GHAA,1995.
23.
HardenS. L.What Legislators Need to Know about Managed Care (brief). Denver: National Conference of State Legislatures, 1994.
24.
HegnerR. E.“Section 1115 Medicaid Waivers: Demonstration or Strategy for Incremental Reform.” Brief no. 662, National Health Policy Forum Research, 1995.
25.
HillmanA. L., PaulyM. V., KermanK., and MartinekC. R.“HMO Managers’ Views on Financial Incentives and Quality.”Health Affairs10 (1991): 207–19.
26.
HillmanA. L., PaulyM. V., and KersteinJ.“How Do Financial Incentives Affect Physicians’ Clinical Decisions and the Financial Performance of Health Maintenance Organizations?”New England Journal of Medicine321 (1989): 86–92.
27.
HurleyR. E.“Trends in the Organization and Financing of Health Care: Managed Care and Integrated Delivery Systems.” Presentation prepared for the Agency for Health Care Policy and Research User Liaison Program Workshop, Atlanta, GA, February 24, 1995.
28.
ICF Inc.“Study of Incentive Arrangements Offered by HMOs and CMPs to Physicians: Final Report.” Submitted to the Office of the Assistant Secretary for Planning and Evaluation, Department of Health and Human Services (HHS-100-86-0051), 1988.
29.
IglehartJ. K.“Health Policy Report: Rapid Changes for Academic Medical Centers.”New England Journal of Medicine331 (1994): 1391–95.
30.
KassirerJ. P.“Academic Medical Centers under Siege.”New England Journal of Medicine”331 (1994): 1370–71.
31.
LewisB.“HMO Outcomes Research: Lessons from the Field.”Journal of Ambulatory Care Management18 (1995): 47–55.
32.
MakucD. M., FreidV. M., and ParsonsP. E.Health Insurance and Cancer Screening in Women (Advance Data 254, August 3). Hyattsville, MD: National Center for Health Statistics, 1994.
33.
McGeeJ., and KnutsonD.“Health Care Report Cards: What about Consumers’ Perspectives?”Journal of Ambulatory Care Management17 (October 1994): 1–14.
34.
MillerR. H., and LuftH. S.“Diversity and Transition in Health Insurance Plans.”Health Affairs10 (1991): 37–47.
35.
MillerR. H., and LuftH. S.“Managed Care Plan Performance since 1980.”Journal of the American Medical Association271 (May 1994): 1512–19.
36.
MurrayD.“Why Three out of Four Doctors Participate in Managed Care.”Medical Economics71 (November 1994): 116–34.
37.
National Committee for Quality Assurance.Medicaid HEDIS (draft). Washington, DC: NCQA, July 6, 1995.
38.
PatricelliR. E.“Why Do We Need Health Alliances?”Health Affairs13 (1994): 239–49.
39.
PearsonS. A., LeeT. H., LindseyE., HawkinsT., CookE. F., and GoldmanL.“The Impact of Membership in a Health Maintenance Organization on Hospital Admission Rates for Acute Chest Pain.”Health Services Research29 (April 1994): 59–73.
40.
PorellF. W., and TompkinsC. P.“Medicare Risk Contracting: Identifying Factors Associated with Market Exit.”Inquiry30 (Summer 1993): 157–69.
41.
RiceT., and GabelJ.1996. The internal economics of HMOs: A research agenda.Medical Care Research and Review, 53 (Suppl.), S44–S64.
42.
RileyG. F., PotoskyA. L., LubitzJ., and BrownM. L.“Stage of Cancer at Diagnosis for Medicare HMO and Fee-for-Service Enrollees.”American Journal of Public Health84 (1994): 1598–604.
43.
RogersM. C., SnydermanR., and RogersE. L.“Sounding Board: Cultural and Organizational Implications of Academic Managed-Care Networks.”New England Journal of Medicine331 (1994): 1374–77.
44.
RosenbaumJ. D., and DarnellJ.“Medicaid Section 1115 Waivers: Approved and Proposed Activities as of November 1994.” Prepared for the Kaiser Commission on the Future of Medicaid, Washington, DC, November 1994.
45.
RosenthalG. E., and HarperD. L.“Cleveland Health Quality Choice: A Model for Collaborative Community-Based Outcomes Assessment.”Joint Commission Journal of Quality Improvement20 (1994): 425–42.
46.
SandyL. G., FosterN. E., and EisenbergJ. M.“Challenges to Generalism: Views from the Delivery System.”Academic Medicine70 (January 1995 Suppl.): S44–46.
47.
ShielsJ. F., LewinL. S., and HaughtR. A.“Potential Public Expenditures under Managed Competition.”Health Affairs12 (1993 Suppl.): 229–42.
48.
StainesV. S.“Potential Impact of Managed Care on National Health Spending.”Health Affairs12 (1993 Suppl.): 248–56.
49.
StarfieldB.“The Promise of HMOs: Primary Care, Prevention, Research and Education.”HMO Practice7 (September 1993): 103–9.
50.
SternR. S., JuhnP. I., GertlerP. J., and EpsteinA. M.“A Comparison of Length of Stay and Costs for Health Maintenance Organization and Fee-for-Service Patients.”Archives of Internal Medicine149 (1989): 1185–88.
51.
TaylorR. S.“How Managed Care Redefines Quality in Consumer Terms.”Journal of Health Care Benefits4 (November/December 1994): 9–15.
52.
TussingA. D., and WojtowyczM. A.“Health Maintenance Organizations, Independent Practice Associations, and Cesarean Section Rates.”Health Services Research29 (April 1994): 75–92.
53.
UdvarhelyiI. S., JennisonK., PhillipsR. S., and EpsteinA. M.“Comparison of the Quality of Ambulatory Care for Fee-for-Service and Prepaid Plans.”Annals of Internal Medicine115 (1991): 394–400.
54.
VeblenT.Imperial Germany and the Industrial Revolution.Ann Arbor: University of Michigan Press,1968.
55.
VernonS.W., HughesJ. I., HeckelV. M., and JacksonG. L.“Quality of Care for Colorectal Cancer in a Fee-for-Service and Health Maintenance Organization Practice.”Cancer69 (1992): 2418–25.
56.
WaxmanM.“Managed Care Contracts: A Focus on Physician Incentive Plans.”Group Practice Journal42 (November/December 1993): 34–37.
57.
WeinerJ. P., LylesA., SteinwachsD., and HallK. C.“Impact of Managed Care on Prescription Drug Use.”Health Affairs10 (1991): 141–54.
58.
WeitekampM. R., and ZiegenfussJ. T.“Academic Health Centers and HMOs: A System Perspective on Collaboration in Training Generalists Physicians and Advancing Mutual Interests.”Academic Medicine70 (January 1995 Suppl.): S47–52.
59.
WelchW. P., HillmanA. L., and PaulyM. V.“Toward New Typologies for HMOs.”Milbank Quarterly68 (1990): 223–43.
60.
YelinE. H., ShearnM. A., and EpsteinW. V.“Health Outcomes for a Chronic Disease in Prepaid Group Practice and Fee-for-Service Settings.”Medical Care24 (1986): 236–47.
