Does anybody have links, sources of publications which evaluated patient coordination / Patient communication / Patient structured care approaches within a HMO setting (health maintenance or health fund / health insurance setting)?
Big thanks for any hints
Alexander
There is a literature on this subject, and I believe you can find it by searching on Google or other standard search engine and by searching on PubMed. I am attaching a couple of articles. One, is from Israel's second largest HMO, Maccabi, an organization with a highly sophisticated information system. Maccabi is primarily a network model HMO. The paper reports more effective and efficient management of patients with complex chronic conditions. The other compares results in different models of Medicaid managed care plans in the US. The paper concludes that there is a primary care case management approach that is more efficient than the HMO approach.
So, what can we learn from this? First, the literature is mixed. Accordingly, I think it is important to remember that "HMO" is a generic term. In some HMOs, particularly staff model HMOs, care tends to be more tightly/carefully managed than in others. Some HMOs primarily manage total cost and do not necessarily achieve their cost targets through carefully managing or coordinating the care process.
Dear Stephen - a very big thanks from Berlin. Background is that in Germany these issues are increasing relevant for healthcare reform issues. Your comments helped me a lot - best from sunny Berlin - Alexander
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