title: Developing a tool for analyzing medical care utilization of adult asthma patients in indemnity and managed care plans: can an episodes of care framework be used?
abstract: We evaluated the health care resource utilization between adult asthma patients in managed care organizations with those in indemnity plans using an episodes of care methodology. We also examined the importance of risk adjustment in explaining variation in resource utilization. Episodes were constructed using private insurance claims from 1992 to 1993. Bivariate and multivariate analyses were used to examine differences between managed care and indemnity plans on episode severity, resource utilization, and outcome measures (asthma-related hospitalizations and emergency room visits). Managed care plans showed higher resource utilization in terms of services and payments per episode compared with fee-for-service plans. Financial incentives to both providers and patients may have contributed to the higher utilization among managed care patients. An episodes of care methodology has potential to serve as a cost-effective "tool" in analyzing trends in medical care utilization within a health care plan. Validation of this methodology is necessary, however, before it can be used to compare trends in utilization across health plans.
authors.affiliation: Center for Health Quality, Outcomes and Economic Research, Bedford VAMC, MA 01730, USA.
authors.forename: A K
authors.initials: AK
authors.lastname: Rosen
authors.forename: A
authors.initials: A
authors.lastname: Mayer-Oakes
mesh_terms: D000328:Adult; D000465:Algorithms; D000704:Analysis of Variance; D001249:Asthma / Q000628:therapy*; D015897:Comorbidity; D017050:Episode of Care; D018588:Fee-for-Service Plans / Q000706:statistics & numerical data*; D005260:Female; D006295:Health Resources / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D008329:Managed Care Programs / Q000706:statistics & numerical data*; D008875:Middle Aged; D012044:Regression Analysis; D020379:Risk Adjustment; D012307:Risk Factors; D012720:Severity of Illness Index; D014481:United States; D014600:Utilization Review