Thesis (Ph. D.)--University of Texas at Austin, 1998. / Vita. Includes bibliographical references (leaves 237-241). Available also in a digital version from Dissertation Abstracts.

Thesis (D.P.H.)--University of Michigan, 2004. / Includes bibliographical references.

Dissertation (D.P.H.)--University of Michigan, 2004. / Includes bibliographical references.

The purpose of this study is to explore differences in quality between Medicare Accountable Care Organizations (ACO) and Health Maintenance Organizations (HMO). Three outcomes measures reported by these plans use different methodologies but possess enough alignment to permit comparison: percent of diabetic patients with last HbA1c > 9.0%, colon cancer screening rate and ER visits per 1,000. These outcomes are the dependent variables (DV). A secondary purpose is to explore differences in quality based on the size of the beneficiary population served, using the same measures. As the Medicare program faces threats to its solvency in coming decades, with 10,000 baby boomers becoming eligible every day, and the ongoing national conversation about healthcare more generally, approaches to Value-Based Purchasing (VBP) are becoming more common. Organizations seeking to identify the types of VBP arrangements in which they should enter have precious little information on the comparative performance of VBP approaches relative to outcomes measures. Different structures create different incentives through the plan design and risk/reward. The convergence or dissipation of the plan incentives at the level of the provider, particularly in primary care, may be a source of variance. This study is retrospective, non-experimental, and uses publicly available data on the performance of Medicare ACO and HMO plans in calendar year 2015, for the identified measures. Using the Donabedian Structure-Process-Outcome framework, this study explores the impact of structure by type of plan and size of population served, relative to the outcomes. Race, average Hierarchical Condition Category (HCC) risk score and duration of operations are control variables. The analysis uses multiple hierarchical regression to better understand the relationship between the independent variables (IV) and DVs, after the impact of the control variables (CV). After controls, the IVs did offer some explanation of variation in outcomes. The ACO plans fared better on HbA1c control, while HMO plans had fewer ER visits per 1,000. No discernable difference existed between the HMO and ACO plans with regard to colon cancer screening rate. Serving larger populations led to better performance on all three measures. In general performance was worse on each measure in both models when the percent of not-White patients or average HCC risk score increased. A longer duration of operations also associated to better performance on the outcome measures.

Made available in DSpace on 2009-11-18T19:01:21Z (GMT). No. of bitstreams: 1 ACF164.pdf: 430647 bytes, checksum: 50ce0289098209cf31ef0a474324a655 (MD5) Previous issue date: 2007 / This case study investigates, empirically, cost methods and criteria of price discrimination made from hospital organizations when they set up their prices of hospital services to private patients and push down their prices to patients affiliated to health insurance and/or health maintenance organizations (HMO). The theory sought to show the Brazilian health systems either public or private, the aspects about corporate culture, the relationship among three players of the private health system ¿ health insurance companies (or HMO), hospitals and the patients, the importance of the cost systems, and the criteria of price discrimination. With these theories, it was developed a qualitative exploratory research, through open interviews, with hospital¿s managers and co-workers from invoicing department from two hospitals located at the Rio de Janeiro City. Based on results we didn¿t identify appropriate cost systems to help the managers to make a correct decision about price discrimination, but was identified corporate culture factors that could influence the price discrimination. Among the results, we can see unprepared hospital managers. Finally, we discussed some contributions and weakness of this case study, and there are presented suggestions for future researches. / O presente estudo de caso investiga, de forma empírica, os métodos de custeio e os critérios de discriminação de preços realizados pelas organizações hospitalares quando da definição de preços para os atendimentos a pacientes particulares e àqueles oriundos de planos de saúde e/ou seguro saúde. Para isso, o referencial teórico utilizado procurou abranger os sistemas de saúde público e privado, os aspectos relativos à cultura organizacional, a relação existente entre os três atores do processo ¿ planos de saúde, prestadores de serviços médicohospitalares e consumidores, a importância dos sistemas de apuração e análise de custos, os critérios de discriminação de preços. Com essa base teórica foi desenvolvida uma pesquisa qualitativa exploratória em duas unidades hospitalares sediadas no município do Rio de Janeiro, através de entrevistas em profundidade, junto a seus gestores hospitalares e a funcionários dos setores de faturamento daquelas entidades. O desenvolvimento da pesquisa não identificou sistemas de gerenciamento de custos adequados para auxiliar os gestores na definição dos preços, mas foram identificados fatores culturais que pudessem influenciar a discriminação desses preços. Dentre os resultados obtidos, destaque para o aparente despreparo na área administrativa e de controladoria dos gestores hospitalares. Ao final, são discutidas as contribuições da pesquisa, suas limitações e as sugestões para o desenvolvimento de futuros estudos.