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July 1, 2004 | Program Result
From 2002 to 2003, research staff at URAC studied utilization management companies to learn how they use utilization management technology and processes to identify and manage potential patient safety problems.
September 1, 2000 | Program Result
From 1996 to 1998, Harvard Pilgrim Health Care examined how insurers, employers and other purchasers of health care decide which medical technologies to provide to consumers under resource constraints.
June 1, 1999 | Program Result
From 1992 to 1997, researchers at the University of Washington School of Public Health and Community Medicine evaluated the effects of utilization management on health care quality and access.
March 1, 1998 | Program Result
The Hastings Center, a nonprofit bioethics research institute located in Garrison, N.Y., used applied research to examine the ethical questions involved with resource allocation by managed care organizations.
April 1, 1997 | Program Result
The University of California, Los Angeles, School of Medicine examined how the structure and intensity of utilization management in physician groups with capitated contracts affect primary care physician and patient satisfaction.
September 1, 2011 | Report
This article explores the indirect, or spillover, health care effects of a high uninsurance rates. Working-age adults with private insurance living in areas with a high rate of uninsurance were less likely than their peers in areas with a low uninsurance rate to have a usual source of care, an office-based visit, and any medical care expenditures.
September 19, 2011 | Program Result
In 2009 and 2010, researchers at UCLA and RAND measured the impact of high local rates of uninsurance on access to care and the quality of care among adults with health insurance.
August 1, 2003 | Program Result
In this 2000–2001 project, Linda Bergthold, PhD, and researchers at Stanford University, Stanford, Calif., surveyed health plan medical directors in 48 states about medical necessity decision making. The study provides input for policy-making at the state and national levels.
January 1, 2001 | Program Result
During the 1980s, expenditures on pharmaceuticals nationwide increased by 152 percent. HMOs implemented a number of cost-control mechanisms to slow the rate of growth of pharmaceutical expenditures, and were successful in doing so compared to fee-for-service health plans.
November 1, 1996 | Program Result
Harvard Pilgrim Health Care documented the implicit criteria used to determine "medical necessity" related to mental health, and the influences of financial incentives and organizational arrangements on medical necessity decisions.