Managing and Evaluating Healthcare Intervention ProgramsSince its publication in 2008, Managing and Evaluating Healthcare Intervention Programs has become the premier textbook for actuaries and other healthcare professionals interested in the financial performance of healthcare interventions. The second edition updates the prior text with discussion of new programs and outcomes such as ACOs, Bundled Payments and Medication Management, together with new chapters that include Opportunity Analysis, Clinical Foundations, Measurement of Clinical Quality, and use of Propensity Matching. |
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Contents
Clinical Background | 15 |
Care Management Programs and Interventions | 45 |
5 | 105 |
The Use of the Value Chain in Care Management Program Planning | 119 |
Clinical Quality and its Measurement | 129 |
Understanding the Economics of Care Management Programs | 163 |
The Example of Opportunity Analysis | 183 |
Measuring Care Management Savings Outcomes | 197 |
Chronic and NonChronic Member Trends | 251 |
Random Fluctuations and Validity in Measuring | 269 |
1 Criteria used to Classify Members into Chronic Categories | 291 |
15 | 293 |
16 | 313 |
PART IV | 332 |
Selective Review of the Literature | 353 |
The Relationship Between Health Risk Factors | 371 |
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Common terms and phrases
achieved actuaries adjustment admissions allow analysis applied assessment associated average baseline benefit blood calculation changes Chapter chronic chronic population claims clinical compared components considered continue cost definition developed Diabetes diagnosis discussed Disease Management DM program drug economic effect eligible employer enrollment estimate evaluation example excluded experience factors Failure glucose health plan health risk healthcare heart higher hospital identified impact important improvement increase individual initiatives intervention issues Journal literature lower management programs mean measurement Medicare method methodology months non-chronic organizations outcomes patients Percentage performance period physician PMPM population potential practice predictive prevalence prevention primary productivity promotion reduce reference reported risk savings score selection significant specific standard Table treatment trend utilization variables