Medicare policymakers are considering testing population-based disease management (PDM) programs under fee-for-service (FFS) Medicare as a way to improve health and cost outcomes for selected subgroups of chronically ill beneficiaries. This paper provides a brief overview of how PDM programs are evolving in the private sector and describes how they differ from other approaches already being tes...

The Medicare Program is conducting a randomized trial of care management services among fee-for-service (FFS) beneficiaries called the Medicare Health Support (MHS) pilot program. Eight disease management (DM) companies have contracted with CMS to improve clinical quality, increase beneficiary and provider satisfaction, and achieve targeted savings for chronically ill Medicare FFS beneficiaries...

Fee-For-Service (FFS) contracts, first introduced in 2004, dramatically changed the way the pharmaceutical distribution supply chains are designed, managed, and operated. Investment buying (IB), forward buying in anticipation of drug price increases, used to be the way the distributors made most of their profits! FFS contracts limit the amount of inventory distributors can carry at any time (by...

This study explores the impact of program structure on children's use of care by comparing care use in State Children's Health Insurance Program (SCHIP) and Medicaid covered populations in a State where children share the same provider network and are both in a primary care case management system with the same Medicaid fee structure. We then compare care use in this system to care use in an SCH...

To study the effects of managed care on dialysis patients, we compared the quality of life and patient satisfaction of patients in a managed care demonstration with three comparison samples: fee-for-service (FFS) patients, managed care patients outside the demonstration, and patients in a separate national study. Managed care patients were less satisfied than FFS patients about access to health...

BACKGROUND National Health and Nutrition Examination Survey (NHANES) records have been linked to health care use and expenditure information from Medicare records. Claims data are generally available only for traditional fee-for-service (FFS) enrollees and not for Medicare Advantage enrollees. Differences in health characteristics between Medicare Advantage and traditional FFS enrollees could a...

This paper examines the impact of two reimbursement schemes on patient welfare, readmission rate, and waiting time in a three tiered public healthcare system comprising (a) a public funder who decides on the reimbursement rate to maximize patient welfare, (b) a public healthcare provider (HCP) who decides on the service rate (which affects readmission rate and operating cost), and (c) a pool of...

Objective. To assess the impact of switching from a fee-for-service (FFS) delivery system to managed care on access to, use of, and satisfaction with health care for children. Data Sources/Study Setting. A 1998 survey of Medicaid recipients in rural Minnesota. Study Design. Using a quasi-experimental framework, we compare the experiences of children on Medicaid living in counties that had switc...

Previous research has found Medicare risk contract enrollees to be healthier than beneficiaries in fee-for-service (FFS). Medicare Current Beneficiary Survey (MCBS) data were used to examine trends in health and functional status measures among risk contract and FFS enrollees from 1991 to 2004. Risk contract enrollees reported better health and functioning, but the differences tended to narrow ...

The Arizona Long-Term Care System (ALTCS), Arizona's Medicaid program for long-term care (LTC) beneficiaries, capitates contractors to provide a full range of acute and LTC services to financially-eligible beneficiaries determined to be at risk of institutionalization. This article compares the acute care utilization experience of LTC beneficiaries in ALTCS with those in a fee-for-service (FFS)...