Bibliography

Is it necessary that some patients come to see us so often? Factors associated with primary care use in pediatrics

Gac Sanit 14:195-202. Published in Spanish. Centro de Salud de Astrabudúa (Bizkaia), Osakidetza-Servicio Vasco de Salud, Bilbao, Spain OBJECTIVES: To analyze the relationship between pediatric […]

Provider profiling: doing it right

Healthplan 41:74-79. Medstat Group, Washington, DC, USA Managed care plans are a type of health insurance. They have contracts with health care providers and medical facilities […]

Emergency department use by the rural elderly

J Emerg Med 18:289-297. Department of Family Medicine, University of Washington, Seattle, WA, USA This study uses Medicare data to compare emergency department (ED) use […]

Do physicians who diagnose more mental health disorders generate lower health care costs?

J Fam Pract 49:305-310. University of Rochester School of Medicine, New York, NY, USA BACKGROUND: Underrecognition and undertreatment of mental health disorders in primary care […]

Why do physicians vary so widely in their referral rates?

J Gen Intern Med 15:163-168. Department of Family Medicine, University of Rochester, Rochester, NY, USA OBJECTIVE: To determine which physician practice and psychological factors contribute […]

Risk adjustment of capitation payments to behavioral health care carve-outs: how well do existing methodologies account for psychiatric disability?

Health Care Manag Sci 3:159-169. Division of General Internal Medicine and Health Services Research, UCLA Department of Medicine, Los Angeles, CA, USA This study used […]

ACG case-mix system aids contract assessment, improves performance

Data Strateg Benchmarks 4:21-26. The ABCs of ACGs. Adjusted clinical groups, or ACGs, a risk adjustment system developed by Baltimore-based Johns Hopkins University, are being […]

Risk adjusting capitation: applications in employed and disabled populations

Health Care Manag Sci 3:101-109. Department of Health Services, University of Washington, Seattle, WA, USA Risk adjustment may be a sensible strategy to reduce selection […]

The effect of the doctor-patient relationship on emergency department use among the elderly

Am JPublic Health 90:97-102. Department of Family Medicine, University of Washington School of Medicine, Seattle, WA, USA OBJECTIVES: This study sought to determine the rate […]

Medi-Cal and managed care: risk, costs, and regional variation

Sacramento, CA, USA: Public Policy Institute of California. Rollins School of Public Health, Emory University, Atlanta, GA; School of Public Health, University of Alabama at […]

Risk aversion and costs: a comparison of family physicians and general internists

J Fam Pract 49:12-17. Department of Family Medicine, University of Rochester, New York, NY, USA No abstract Comment in: Interspeciality differences in medical resource utilization. […]

Minimal-burden risk adjusters for the Medicare risk program

Medical College of Virginia Associated Physicians, Mathematica Policy Research. Report prepared for the Health Care Financing Review (HCFA Contract No. 17C-90366/3/01). Washington, DC, USA: Mathematica […]

The development of Ambulatory Care Groups in primary care

Rev Neurol 29:667-669. Published in Spanish. Fundació Jordi Gol i Gurina, Barcelona, España INTRODUCTION: Ambulatory care groups (ACG) are a system of classification for patients […]

Development and estimation of a pediatric chronic disease score using automated pharmacy data

Med Care 37:874-883. Center for Health Studies, Group Health Cooperative of Puget Sound, Seattle, WA, USA BACKGROUND: Although risk assessment models for specific adult populations […]

The Adjusted Clinical Group (ACG) reporting framework

Reporting Framework Subcommittee of the Steering Committee of the Minnesota ACG Users Group. St. Paul, MN, USA: Minnesota ACG Users Group. Minnesota ACG Users Group, […]

Risk distribution and risk assessment among enrollees in Washington state’s Medicaid SSI population

Hamilton, NJ, USA: Center for Health Care Strategies. Center for Health Care Strategies, Hamilton, NJ, USA Washington state began enrolling Medicaid SSI (low income, disabled) […]

Description, behavior, use and methodology used to measure case mix in our primary health care system: the Ambulatory Care Groups (ACGs)

Barcelona, Spain: Fundacio Salut, Empresa i Economia. Published in Spanish. Fundacio Salut, Empresa i Economia, Barcelona, Spain No abstract

Risk adjustment and Medicare

New York, NY, USA: Commonwealth Fund. Division of Health Policy Research and Education, Harvard University, Boston, MA, USA Almost all observers agree in principle that […]

Measuring morbidity in populations: performance of the Johns Hopkins Adjusted Clinical Group (ACG) case-mix adjustment system in Manitoba

Winnipeg, MB, Canada: Manitoba Centre for Health Policy. Manitoba Centre for Health Policy, Winnipeg, MB, Canada This study examined the performance of the Johns Hopkins […]

Medicaid managed care payment rates in 1998

Health Aff 18:217-227. Urban Institute, Washington, DC, USA This paper reports on a new survey of state Medicaid managed care payment rates. We collected rate […]

The prospective risk adjustment system

J Ambul Care Manage 22:41-52. 3M Health Information Systems, Wallingford, CT, USA The Episode Classification System is intended to perform two tasks. First, it will […]

The duration of ambulatory visits to physicians

J Fam Pract 48:264-271. Institute for Health Policy, Massachusetts General Hospital/Partners HealthCare System, Harvard Medical School, Boston, MA, USA BACKGROUND: The objective of our study […]

Variations in primary care physician referral rates

Health Serv Res 34:323-329. University of Rochester, Rochester, NY, USA OBJECTIVE: To examine primary care physician referral rate variations, including their extent and their stability […]

Application of the Ambulatory Care Groups in the primary care of a European national health care system: does it work?

Med Care 37:238-248. Astrabudúa Health Center, Osakidetza/Basque Health Service, Bizkaia, Spain BACKGROUND: Ambulatory Care Groups (ACGs), a US case mix system that uses the patient […]

Methods of reducing the financial risk of physicians under capitation

Arch Fam Med 8:149-155. Johns Hopkins Center for Hospital Finance and Management, Baltimore, MD, USA. In today’s rapidly changing medical marketplace, managed care plans are […]

Methods for analyzing health care utilization and costs

Annu Rev Public Health 20:125-144. Department of Biostatistics, University of Washington, Seattle, WA, USA Important questions about health care are often addressed by studying health […]

Performance of an ambulatory case-mix measurement in primary care in Spain: Ambulatory Care Groups (ACGs)

Eur J Public Health 9:27-35. Unitat d’Investigació Centre del Institut Catalá de la Salut, Barcelona, Spain BACKGROUND: Patient classification systems based on the defining of […]

The risk-adjustment debate

N Engl J Med 339:1952-1956. Risk adjustment refers to the adjustment of payments to health plans (or to doctors) to reflect more accurately the actual […]

Building health plan databases to risk adjust outcomes and payments

Int J Qual Health Care 10:531-538. Center for Health Research, Kaiser Permanente, Northwest Division, Portland, OR, USA OBJECTIVES: To highlight the types and sources of […]

Health-based payment and computerized patient record systems

Eff Clin Pract 1:66-72. Center for Health Research, Kaiser Permanente, Northwest Division, Portland, OR, USA. Health care information technology is changing rapidly and dramatically. A […]

The development of a risk-adjusted capitation payment system: the Maryland Medicaid model

J Ambul Care Manage 21:29-52. School of Public Health, Johns Hopkins University, Baltimore, MD, USA This article describes the risk-adjusted payment methodology employed by the […]

The importance of continuity of care in the likelihood of future hospitalization: is site of care equivalent to a primary clinician?

Am J Public Health 88:1539-1541. Department of Family Medicine, Medical University of South Carolina, Charleston, SC, USA OBJECTIVES: This study examined the effect of continuity […]

The role of provider continuity in preventing hospitalizations

Arch Fam Med 7:352-357. Department of Family and Community Medicine, Christiana Care Health System, Wilmington, DE, USA OBJECTIVES: To examine the association between provider continuity […]

The importance of the data quality in the validation of the ACG case mix

Ambulatory Care Groups. Aten Primaria 22:128. Published in Spanish. Osakidetza Servicio Vasco de Salud, Bizkaia, Spain No abstract Comment on:[A retrospective evaluation of the behaviour […]

Implementing a model for risk distribution among competing health plans

Final report. Princeton, NJ, USA: Robert Wood Johnson Foundation.

Risk adjustment and rate setting methods in public programs

A report to legislature. St. Paul, MN, USA: Minnesota Department of Health. Health Economics Program, Minnesota Department of Health, St. Paul, MN, USA The 1995 […]

How well do models work? Predicting health care costs

In: American Statistical Association, eds. Proceedings of the Section on Statistics in Epidemiology. Alexandria, VA, USA: American Statistical Association:42-49. Department of General Internal Medicine, Boston […]

Differences in case mix between CHC users and non users: Washington and Missouri

MDS Associates, Laguna Research Associates. Final report to the Bureau of Primary Health Care. Wheaton, MD, USA: MDS Associates. Wheaton, MD, USA; San Francisco, CA, […]

Employer purchasing coalitions and Medicaid: experiences with risk adjustment

New York, NY, USA: Commonwealth Fund. Commonwealth Fund, New York, NY, USA Choice among health plans increases patient satisfaction with care and enables families to […]

Primary care physician compensation method in medical groups: does it influence the use and cost of health services for enrollees in managed care organizations?

JAMA 279:853-858. Department of Health Services, University of Washington, Seattle, WA, USA CONTEXT: Growth of at-risk managed care contracts between health plans and medical groups […]

Managed care holds down costs, doesn’t hurt quality

Minneapolis Star Tribune, January 3:A13. No abstract

The Florida MediPass program

Chapter 4. In: Gavin NI, Farrelly MC, ed. Evaluation of Medicaid managed care programs with 1915(b) waivers. Presented to HCFA Office of R&D. Rockville, MD, […]

The New Mexico primary care network

Chapter 5. In: Gavin NI, Farrelly MC, ed. Evaluation of Medicaid managed care programs with 1915(b) waivers. Presented to HCFA Office of R&D. Rockville, MD, […]

Risk adjustment of mental health and substance abuse payments

Inquiry 35:223-239. Department of Health Care Policy, Harvard Medical School, Boston, MA, USA This study used 1992 and 1993 data from private employers to compare […]

Case study: the Minneapolis Buyers Health Care Action Group

Inquiry 35:171-177. Health Research Center, Institute for Research and Education, Health System Minnesota, Minneapolis, MN, USA Managed care plans are a type of health insurance. They […]

Cost benefit analysis of pharmaceutical care in a Medicaid population – from a budgetary perspective

J Managed Care Pharm 4:303-308. Nova Southeastern University, Ft. Lauderdale, FL, USA The objective was to evaluate the economic impact of Medicaid pharmaceutical care services […]

Preventable hospitalizations and socioeconomic status.

Health Aff 17:177-189. Wagner Graduate School, New York University, New York, NY, USA. “Preventable” hospitalizations have been proposed as indicators of poor health plan performance. […]

Adjust utilization for case mix and make physicians responsible for remaining variation

Data Strateg Benchmarks 2:25-28. “But my patients are sicker!” Health Source/CIGNA put a stop to this physician complaint by switching to quarterly physician profiles that […]

A retrospective evaluation of the behaviour of groups under out-patient care at a health center

Aten Primaria 21:36-42. Published in Spanish. Escuela Andaluza de Salud Pública de Granada, Granada, Spain OBJECTIVES: To study and analyse the Out-Patient Care Groups (OCGs), […]

Children’s health care use in the Healthy Kids Program

Pediatrics 100:947-953. Department of Pediatrics, University of Florida, Gainsville, FL, USA BACKGROUND: In 1990, the Florida Legislature established the Florida Healthy Kids Corporation to implement […]

Hopkins health pricing tool a managed care hit

Hopkins health pricing tool a managed care hit. Baltimore Business Journal July 21. Baltimore Business Journal, Baltimore, MD, USA Johns Hopkins University’s links with private […]

ACGs: an ambulatory care case-mix measure. Health Quality section update

Center for Health Quality Outcomes and Economic Research. Bedford, MA, USA: CHQOER Quarterly, ENRM VA Hospital. Center for Health Quality Outcomes and Economic Research, Bedford, […]

How well do Ambulatory Care Groups predict expenditures on mental health and substance abuse patients?

Adm Policy Ment Health 24:339-357. Department of Health Care Policy, Harvard Medical School, Boston, MA, USA This paper evaluates the ability of Ambulatory Care Groups […]

A patient classification system for our primary care: the Ambulatory Care Groups (ACGs)

Gac Sanit 11:83-94. Published in Spanish. Unitat d’Investigació Centre del Institut Catalá de la Salut, Barcelona, Spain OBJECTIVES: The ambulatory care groups (ACGs) were developed […]

Performance of risk adjusted capitated systems in allocating a global budget

Baltimore, MD, USA: Johns Hopkins University (doctoral dissertation). Johns Hopkins University, Baltimore, MD, USA Rapidly rising health care costs in the United States have led […]

Maryland to test new Medicaid managed care pay formula

Am Med News December 2.

Taking health status into account when setting capitation rates: a comparison of risk-adjustment methods

JAMA 276:1316-1321. Health Research Center, Institute for Research and Education, HealthSystem Minnesota, Minneapolis, MN, USA OBJECTIVE: To compare performance of different health status measures for […]

Systemwide provider performance in a Medicaid program. Profiling the care of patients with chronic illnesses

Med Care 34:798-810. Department of Health Policy and Management, Johns Hopkins University School of Public Health, Baltimore, MD, USA OBJECTIVES: This study illustrates how claims […]

Capitation adjustment for pediatric populations

Pediatrics 98:10-17. Institute for Research and Education, HealthSystem Minnesota, Minneapolis, MN, USA OBJECTIVE: The objective of this study is to assess the predictive performance of […]

Developing re-insurance and carve-out risk adjusters for an under 65 population

Johns Hopkins University, Lewin Group. Prepared for Health Care Financing Administration. Fairfax, VA, USA: Lewin Group. Johns Hopkins University, Baltimore, MD, USA; Lewin Group, Fairfax, […]

Evaluation of casemix adjustment methods for the Massachusetts Division of Medical Assistance

Massachusetts Rate Setting Commission. Final report and recommendation. Boston, MA, USA: Massachusetts Rate Setting Commission. Massachusetts Rate Setting Commission, Boston, MA, USA We investigated methods […]

The development and testing of risk adjusters using Medicare inpatient and ambulatory data

Final report for Health Care Financing Administration contract 93-026/EE. Falls Church, VA, USA: Lewin Group. Lewin Group, Falls Church, VA, USA The Health Care Financing […]

Quality assessment: is the focus on providers or on patients?

Int J Qual Health Care 8:231-241. Department of Psychiatry, University of Pittsburgh, Pittsburgh, PA, USA Most studies of ambulatory care quality are based on chart […]

Profiling resource use by primary-care practices: managed Medicare implications

Health Care Financ Rev 17:23-42. Project HOPE Center for Health Affairs, Bethesda, MD, USA Variations in elderly Medicare beneficiaries’ health service use are examined using […]

Risk-adjusted Medicare capitation rates using ambulatory and inpatient diagnoses

Health Care Financ Rev 17:77-99. Johns Hopkins School of Public Health, Baltimore, MD, USA Researchers at The Johns Hopkins University (JHU) developed two new diagnosis-oriented […]

Ambulatory care practice variation within a Medicaid program

Health Serv Res 30:751-770. Johns Hopkins University, School of Public Health, Department of Health Policy and Management, Baltimore, MD, USA STUDY QUESTIONS: What is the […]

Classification systems in case-mix groups in ambulatory care. Perspectives for our primary health care

Aten Primaria 17:76-82. Published in Spanish. Unitat d’Investigació Centre, Institut Català de la Salut, CESCA, Barcelona, Spain No abstract PMID: 8742149

Ambulatory Care Groups and the profiling of primary care physician resource use: examining the application of case mix adjustments

J Ambul Care Manage 19:86-89. Center for Research in Ambulatory Health Care Administration, Englewood, CO, USA A variety of profiling models and tools is utilized […]

Health information services technologies

J Ambul Care Manage 19:90-97. ISYS Group, Des Moines, IA, USA Increasing demands for provider profiling have led to the growth of health information services […]

Profiling primary care physician resource use: examining the application of case mix adjustment

J Ambul Care Manage 19:60-80. Health Services Research and Development Center, Johns Hopkins School of Public Health, Baltimore, MD, USA Growing emphasis on managed care […]

HMO family physicians: men and women differ in their work

HMO Pract 9:155-161. Group Health Cooperative of Puget Sound, Seattle, WA, USA OBJECTIVE: The goal was to identify differences in the type of work and […]

Geographic variation in primary care visits in Iowa.

Health Serv Res 30:657-671. Graduate Program in Hospital and Health Administration, University of Iowa, Iowa City, IA, USA. OBJECTIVE: This study investigates the determinants of […]

A chronic disease score with empirically derived weights

Med Care 33:783-795. Indiana University Department of Medicine, Indianapolis, IN, USA. Different types of medication prescribed during a 6-month period for the treatment and management […]

A comparative analysis of methods of health risk assessment: final report

Cambridge, MA, USA: Harvard University School of Public Health. Harvard University School of Public Health, Cambridge, MA, USA A key component of many recent proposals […]

Assessment of Ambulatory Care Groups with comparison to existing ambulatory case-mix classification systems

Systems Research and Applications Corporation. Arlington, VA, USA: Systems Research and Applications Corporation. Systems Research and Applications Corporation, Arlington, VA, USA The Office of the […]

Models for Medicare payment system reform based on group-specific volume performance standards (GVPS)

Waltham, MA, USA: Brandeis University. Brandeis University, Waltham, MA, USA This report discusses potential policy options for Medicare based on Group-Specific Volume Performance Standards (GVPS). […]

Ambulatory care casemix measures

J Gen Intern Med 10:162-170. HSR&D Field Program, Edith Nourse Rogers Memorial Veterans Hospital, Bedford, MA, USA No abstract PMID: 7769475

Forecasting physician workforce requirements

JAMA 273:111; author reply 113. Dr Weiner1 presents an exacting analysis of the likely effects of health system reform on physician workforce requirements. His market approach […]

Designing and using measures of quality based on physician office records.

J Ambul Care Manage 18:56-72. Harvard School of Public Health, Harvard University, Boston, MA, USA This article presents our principles for developing performance measures to […]

Costs vs quality in different types of primary care settings

JAMA 272:1903-1908. Department of Health Policy and Management, School of Hygiene and Public Health, Johns Hopkins University, Baltimore, MD, USA OBJECTIVE: To determine the relationship […]

The case for case-mix adjustment in practice profiling. When good apples look bad

JAMA 272:871-874. Harvard Community Health Plan, Brookline, MA, USA OBJECTIVE: To assess the influence of patient characteristics on practice profiling. Using the example of specialty […]

The ambulatory case-mix development project

Project final report. Baltimore, MD, USA: Johns Hopkins University and Aetna Health Plans. Johns Hopkins University and Aetna Health Plans, USA As the US health […]

A comparison of alternative approaches to risk measurement

Final report, grant number 93-G07, Physician Payment Review Commission. Minneapolis, MN, USA: Park Nicollet Medical Foundation. Park Nicollet Medical Foundation, Minneapolis, MN, USA Under health […]

Applying population-based case mix adjustment in managed care: the Johns Hopkins Ambulatory Care Group system

Manag Care Q 2:21-34. CSC Healthcare Systems, Inc., Malden, MA, USA When analyzing medical utilization or other health care-related measurements across provider panels, case mix […]

Ambulatory Care Groups: an evaluation for military health care use

Fort Sam Houston, TX, USA: United States Army Center for Healthcare Education and Studies, publication #HR 94-004. United States Army Center for Healthcare Education and […]

Patient-mix differences among ambulatory providers and their effects on utilization and payments for Maryland Medicaid users

Med Care 31:1119-1137. Policy and Health Statistics Administration, Maryland Department of Health and Mental Hygiene, Baltimore, MD, USA Characteristics of the usual source of care […]

Developing and evaluating performance measures for ambulatory care quality: a preliminary report of the DEMPAQ project

Jt Comm J Qual Improv 19:552-565. Department of Health Policy and Management, Harvard School of Public Health, Boston, MA, USA Because of the focus on […]

Ambulatory encounter systems: implications for payment and quality

J Ambul Care Manage 16:33-49. Many key decision makers are looking to AESs solely for purposes of payment. This approach is unfortunate because many systems […]

Johns Hopkins Ambulatory Care Groups (ACGs). A case-mix system for UR, QA and capitation adjustment

HMO Pract 6:13-19. Johns Hopkins University, Baltimore, MD, USA This paper describes a new ambulatory case-mix system developed at The Johns Hopkins University and known […]

Case mix measures for ambulatory care

J Public Health Med 13:189-197. University of Newcastle upon Tyne, School of Health Care Sciences, Medical School, Newcastle, UK Resource management in Ambulatory Care is […]

Ambulatory case-mix methodologies: applications to primary care research

In: Grady M, eds. Primary care research: theory and methods. Washington, DC: USDHHS. AHCPR Pub 91-0011:75-81. Johns Hopkins University, Baltimore, MD, USA This paper describes […]

Development and application of a population-oriented measure of ambulatory care case-mix

Med Care 29:452-472. Department of Health Policy and Management, Johns Hopkins University School of Hygiene and Public Health, Baltimore, MD, USA This article describes a […]

Ambulatory care groups: a categorization of diagnoses for research and management

Health Serv Res 26:53-74. Department of Health Policy and Management, Johns Hopkins School of Hygiene and Public Health, Baltimore, MD, USA This article describes a […]

Impact of managed care on prescription drug use

Health Aff 10:140-154. Johns Hopkins University School of Hygiene and Public Health, Baltimore, MD, USA Differences between the health services utilization patterns of persons enrolled […]

ACGs: ambulatory care groupings for case-mix categorization

Final report for grant #HS05505, National Center for Health Care Research/Health Care Technology Assessment. Baltimore, MD, USA: Johns Hopkins University. Johns Hopkins University, Baltimore, MD, […]

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