The study's purpose was to compare characteristics, service utilization, and outcomes of home health patients enrolled in fee-for-service (FFS) versus health maintenance organization (HMO) health plans. Results documented that HMO patients were healthier and used fewer resources than FFS patients. Outcomes for HMO patients were superior to those of FFS patients. Phi correlation coefficients showed that purchaser type was not a substantial predictor of patient outcomes. Home health staff need to begin intense case management of FFS patients to identify when patient outcomes are maximized and continued services will not further improve or stabilize the patient's condition.
National Association of Home Care.1999 Basic statistics about home care. http://www.nahc.org/consumer/hcstats.html. Accessed in September 1999.
2.
Cook J., Ingersoll GL, Spitzer R.Managed care research, part 1: defining the domain. J Nurs Adm. 1999;29(11):23-30.
3.
Lynn M., Layman EL, Richard S.The final chapter in the nursing administration research priority saga. J Nurs Adm.1999;29(5):5-9, 20.
4.
Bonner C., Boyd B. Managed care: threat or opportunity for home health? Online J Issues Nurs. http://www.nursingworld.org/ojin/tpc2/tpc2-5.htm . Accessed in January 1997.
5.
Jones L.Building the information infrastructure required for managed care . Image J Nurs Sch. 1997;29(4):377-382.
6.
Perry A.Capitating home health care. Healthcare Financial Manage. 1998;53(3):39, 41, 43.
7.
Boyd B.Home-health quality and resource utilization in a managed-care organization . In: Adams CE, Anthony A, eds. Home Health Outcomes and Resource Utilization: Integrating Today's Critical Priorities. New York: National League for Nursing; 1997.
8.
Office of Inspector General, Department of Health and Human Services.How HMOs Manage Home Health Services . Atlanta: Office of Evaluation and Inspection; 1997. Report no. OEI-04-95-00080.
9.
Brown RS, Clement DG, Hill JW, Retchin SM, Bergeron JWDo health maintenance organizations work for Medicare? Health Care Financing Rev.1993;15(1):7-23.
10.
Experton B., Li Z., Branch LG, Ozminkowski RJ, Mellon-Lacey DMThe impact of payor/provider type on health care use and expenditures among frail elderly. Am J Public Health. 1997 ;87(2):210-216.
11.
Shaughnessy PW, Schlenker RE, Hittle DFHome health care outcomes under capitated and fee-for-service payment. Health Care Financing Rev.1994;16(1):187-221.
12.
Martin S.OIG: $20 billion in "improper" Medicare payments. Am Med News.1998;41(18):7-8.
13.
Leon J., Neuman P., Parente S.Understanding the Growth in Medicare's Home Health Expenditure. The Kaiser Medicare Policy Project. Menlo Park, CA: Kaiser Family Foundation; 1997.
14.
US General Accounting Office.Medicare: Home Health Utilization Expands While Program Controls Deteriorate . Washington, DC: Government Printing Office;1996. Report no. GAO-HEHS-96-16.
15.
Kenney GM, Dubay LCExplaining area variation in the use of Medicare home health services . Med Care.1992;30(1):43-57.
16.
Kenney GMIs access to home health care a problem in rural areas? Am J Public Health.1993;83(3):412-413.
17.
Schore J.Regional variations in Medicare home health: taking a closer look . http://38.150.5.70/mprweb/hhvexec.htm. Accessed in November 1996.
18.
Welch BG, Wennberg DE, Welch WPThe use of Medicare home health care services. N Engl J Med.1996;335(5):324-329.
19.
Williams B.Comparison of services among different types of home health agencies. Med Care. 1994;32(11 ):1134-1152.
20.
Centers for Health Policy and Services Research.Home Health Agency Manual for the National Medicare Quality Assurance and Improvement Demonstration. Denver: Centers for Health Policy and Services Research; 1995.
21.
Shaughnessy PW, Shenkler RE, Crisler KS, et al. Measuring Outcomes of Home Care: A Study to Develop Outcome-Based Quality Measures for Home Health Services. Denver: Centers for Health Policy and Services Research; 1994.
22.
Hellinger FJAgency on Health Care Policy and Research: health plans that restrict choice of provider attract healthier members. Res Activ.1995;189(6):14-15.
23.
Health Policy Economics Group.Is There a Bias Selection in Medicare HMOs? Washington, DC: Health Policy Economics Group; 1996.
24.
Health Care Financing Administration.Medicare enrollment trends 1966-1998. http://www.hcfa.gov/stats/enrltmd/htm . Accessed in September 1999.
25.
Torrez DJ, Estes C., Linkins K.The impact of a decade of policy on home health care utilization. Home Health Care Serv Q. 1998;16(4):35-56.
26.
Dombi W.Home care coverage through HMOs. Caring. 1993 ;12(6):58-60.
27.
Boling P.Home care in managed care: a new frontier. Remington Rep. 1994;13(6):13-16.
28.
Fortinsky RH , Madigan EAHome care resource consumption and patient outcomes: what are the relationships? Home Health Care Serv Q.1997;16(3):55-73.
29.
Adams CE, Corbett CF, Michel Y.Service utilization and outcomes in rural home health agencies. Outcomes Manage Nurs Pract. 2000;4(2):63-68.
