PURPOSE Medicare's merit-based incentive payment system and narrowing of physician networks by health insurers will stoke clinicians' and policy makers' interest in care delivery attributes associated with value as defined by payers. METHODS To help define these attributes, we analyzed 2009 to 2011 commercial health insurance claims data for more than 40 million preferred provider organizatio...

This article addresses the management of depression in primary care from the perspective of a health maintenance organization. The rise of managed care systems is briefly discussed with reference to their impact on choice of treatment strategies. Cost-effectiveness considerations pertinent to a health maintenance organization are reviewed. A simplified protocol for the treatment of depression w...

OBJECTIVE Patient safety is moving up the list of priorities for hospitals and health care delivery systems, but improving safety across a large organization is challenging. We sought to create a common patient safety strategy for the Partners HealthCare system, a large, integrated, non-profit health care delivery system in the United States. DESIGN Partners identified a central Patient Safet...

BACKGROUND The fragmented nature of health care delivery in the United States leads to fragmented health information and impedes patient care continuity and safety. Technologies to support interorganizational health information exchange (HIE) are becoming more available. Understanding how HIE technology changes health care delivery and affects people and organizations is crucial to long-term su...

excellent record of cost containment. Both of these goals have eluded our system. But the authors (a physician and a professional writer) do not propose to import the American system in one piece. They only wish to borrow particular features. For example, they especially admire the American HMO, and believe that introducing American-style competition and management would eliminate much of the w...

E very form of health care linancing manages the care of Ihe piuient. In particular, health niaintenancc organizations (HMOs) soniciinies are portrayed as "managing" that care so rigidly, that the patients have little opportunity to choose who will treat them or where they will he irealed. Forms of this management, however, vary considerahly. Some plans provide discounts to the patient who sele...

This article explores the impact of intensive competition within the pharmaceutical industry and among private providers on health care in an Indian city. In-depth interviewing and clinical observation were used over a period of 18 months. Private practitioners and chemists who provided regular services to inhabitants of a poor neighborhood in central Bhubaneswar were included. Fierce competiti...

State governments contract with health maintenance organizations (HMOs) to coordinate medical care for nearly 20 million Medicaid recipients. Identifying the causal effect of HMO enrollment on government spending and health care quality is difficult if, as is often the case, recipients have the option to enroll in a plan. To estimate the average effect of HMO enrollment, this paper exploits cou...

The potential for health information technology (IT) to improve health care delivery has been appreciated for decades, but "digitizing" health care can also introduce new risks and even harm. As the use of health IT has grown, these risks have become more apparent. The authors of this report evaluated the efforts of 11 hospitals and ambulatory practices to use an improvement strategy and tools ...

HMO enrollees with limited English proficiency, and particularly those in poorer health, face communication barriers despite language assistance regulations. More than 1.3 million California HMO enrollees ages 18 to 64 do not speak English well enough to communicate with medical providers and may experience reduced access to high-quality health care if they do not receive appropriate language a...