Measuring access to effective care among elderly medicare enrollees in managed and Fee-for-Service care: a retrospective cohort study.
BACKGROUND
Our aim was to compare access to effective care among elderly Medicare patients in a Staff Model and Group Model HMO and in Fee-for-Service (FFS) care.


METHODS
We used a retrospective cohort study design, using claims and automated medical record data to compare achievement on quality indicators for elderly Medicare recipients. Secondary data were collected from 1) HMO data sets and 2) Medicare claims files for the time period 1994-95. All subjects were Medicare enrollees in a defined area of New England: those enrolled in two divisions of a managed care plan with different physician payment arrangements: a staff model, and a group model; and the Medicare FFS population. We abstracted information on indicators covering several domains: preventive, diagnosis-specific, and chronic disease care.


RESULTS
On the indicators we created and tested, access in the single managed care plan under study was comparable to or better than FFS care in the same geographic region. Percent of Medicare recipients with breast cancer screening was 36 percentage points higher in the staff model versus FFS (95% confidence interval 34-38 percentage points). Follow up after hospitalization for myocardial infarction was 20 percentage points higher in the group model than in FFS (95% confidence interval 14-26 percentage points).


CONCLUSIONS
According to indicators developed for use in both claims and automated medical record data, access to care for elderly Medicare beneficiaries in one large managed care organization was as good as or better than that in FFS care in the same geographic area.
Barton
M B
MB
Department of Ambulatory Care and Prevention Harvard Medical School and Harvard Pilgrim Health Care Boston MA, USA. mary_barton@hms.harvard.edu
Dayhoff
D A
DA
Soumerai
S B
SB
Rosenbach
M L
ML
Fletcher
R H
RH
D000208:Acute Disease; D000368:Aged; D000369:Aged, 80 and over; D002908:Chronic Disease; D003266:Continuity of Patient Care; D018588:Fee-for-Service Plans / Q000458:organization & administration* / Q000592:standards; D005260:Female; D006125:Group Practice, Prepaid / Q000458:organization & administration / Q000592:standards; D006279:Health Maintenance Organizations / Q000458:organization & administration* / Q000592:standards; D006297:Health Services Accessibility / Q000458:organization & administration / Q000706:statistics & numerical data*; D006302:Health Services Research; D006801:Humans; D007345:Insurance Claim Review; D008297:Male; D016345:Medicare Part B / Q000592:standards*; D009511:New England; D019984:Quality Indicators, Health Care