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In Medicaid Managed Care Networks, Care Is Highly Concentrated Among A Small Percentage Of Physicians
States have increasingly outsourced the provision of Medicaid services to private managed care plans. To ensure that plans maintain access to care, many states set network adequacy standards that require plans to contract with a minimum number of physicians. In this study we used data from the period 2015-17 for four states to assess the level of Medicaid participation among physicians listed in the provider network directories of each managed care plan. We found that about one-third of outpatient primary care and specialist physicians contracted with Medicaid managed care plans in our sample saw fewer than ten Medicaid beneficiaries in a year. Care was highly concentrated: 25 percent of primary care physicians provided 86 percent of the care, and 25 percent of specialists, on average, provided 75 percent of the care. Our findings suggest that current network adequacy standards might not reflect actual access; new methods are needed that account for beneficiaries' preferences and physicians' willingness to serve Medicaid patients.
Journal Article
Phantom Networks: Discrepancies Between Reported And Realized Mental Health Care Access In Oregon Medicaid
Understanding the extent to which beneficiaries can \"realize\" access to reported provider networks is imperative in mental health care, where there are significant unmet needs. We compared listings of providers in network directories against provider networks empirically constructed from administrative claims among members who were ages sixty-four and younger and enrolled in Oregon's Medicaid managed care organizations between January 1 and December 31, 2018. \"In-network\" providers were those with any medical claims filed for at least five unique Medicaid beneficiaries enrolled in a given health plan. They included primary care providers, specialty mental health prescribers, and nonprescribing mental health clinicians. Overall, 58.2 percent of network directory listings were \"phantom\" providers who did not see Medicaid patients, including 67.4 percent of mental health prescribers, 59.0 percent of mental health nonprescribers, and 54.0 percent of primary care providers. significant discrepancies between the providers listed in directories and those whom enrollees can access suggest that provider network monitoring and enforcement may fall short if based on directory information.
Journal Article
Active directory for dummies
Your guide to learning Active Directory the quick and easy way Whether you're new to Active Directory (AD) or a savvy system administrator looking to brush up on your skills,â¯Active Directory for Dummies will steer you in the right direction.
eBook
Small Business Owners' Success Criteria, a Values Approach to Personal Differences
This study of 150 Dutch small business owners, identified through business/network directories, investigated relationships between owners' understanding of success and their personal values. Business owners ranked 10 success criteria. Personal satisfaction, profitability, and satisfied stakeholders ranked highest. Multidimensional scaling techniques revealed two dimensions underlying the rank order of success criteria: person‐oriented (personal satisfaction versus business growth) and business‐oriented (profitability versus contributing back to society). Furthermore, business growth, profitability, and innovativeness were guided by self‐enhancing value orientations (power and achievement). Softer success criteria, such as having satisfied stakeholders and a good work–life balance, were guided by self‐transcendent value orientations (benevolence and universalism).
Journal Article
Group Policy
Get up to speed on the latest Group Policy tools, features, and best practices Group Policy , Fundamentals, Security, and the Managed Desktop, 3rd Edition help s you streamline Windows and Windows Server management using the latest Group Policy tools and techniques.
eBook
The Advanced BRain Imaging on ageing and Memory (ABRIM) data collection: Study design, data processing, and rationale
To understand the neurocognitive mechanisms that underlie heterogeneity in cognitive ageing, recent scientific efforts have led to a growing public availability of imaging cohort data. The Advanced BRain Imaging on ageing and Memory (ABRIM) project aims to add to these existing datasets by taking an adult lifespan approach to provide a cross-sectional, normative database with a particular focus on connectivity, myelinization and iron content of the brain in concurrence with cognitive functioning, mechanisms of reserve, and sleep-wake rhythms. ABRIM freely shares MRI and behavioural data from 295 participants between 18–80 years, stratified by age decade and sex (median age 52, IQR 36–66, 53.20% females). The ABRIM MRI collection consists of both the raw and pre-processed structural and functional MRI data to facilitate data usage among both expert and non-expert users. The ABRIM behavioural collection includes measures of cognitive functioning (i.e., global cognition, processing speed, executive functions, and memory), proxy measures of cognitive reserve (e.g., educational attainment, verbal intelligence, and occupational complexity), and various self-reported questionnaires (e.g., on depressive symptoms, pain, and the use of memory strategies in daily life and during a memory task). In a sub-sample ( n = 120), we recorded sleep-wake rhythms using an actigraphy device (Actiwatch 2, Philips Respironics) for a period of 7 consecutive days. Here, we provide an in-depth description of our study protocol, pre-processing pipelines, and data availability. ABRIM provides a cross-sectional database on healthy participants throughout the adult lifespan, including numerous parameters relevant to improve our understanding of cognitive ageing. Therefore, ABRIM enables researchers to model the advanced imaging parameters and cognitive topologies as a function of age, identify the normal range of values of such parameters, and to further investigate the diverse mechanisms of reserve and resilience.
Journal Article
Medicaid Managed Care: Access To Primary Care Providers Who Prescribe Buprenorphine
Medicaid managed care insurers play a crucial role in facilitating access to buprenorphine to treat opioid use disorder. Using a novel set of provider directory and prescription claims data, we examined variation in access to in-network buprenorphine-prescribing primary care providers among Medicaid managed care enrollees. Approximately 32.2 percent of enrollees had fewer than one in-network buprenorphine prescriber per 100,000 county residents. On average, there were a greater number of in-network buprenorphine-prescribing primary care providers in states with higher compared with lower overdose death rates. However, most enrollees lived in areas with a shortage of these providers. We found that a 25 percent higher network participation rate by prescribers compared with nonprescribers could improve the probability that enrollees see a prescriber by approximately 25 percent. Policies to improve access within Medicaid managed care include using primary care provider assignment algorithms to match patients with buprenorphine prescribers and requiring that networks include a minimum number of buprenorphine prescribers.
Journal Article
The African American Experience in Cyberspace
The World Wide Web is the greatest source of information used by students and teachers, media and library professionals, as well as the general public. There is so great a flow of information that it is necessary to have a tool for guiding one to the best and most reliable sources. This important new guide to the African American experience in cyberspace fills this need for people in all areas of Black Studies and Multiculturalism. There is no search engine list that can match the quality of sites to be found in this book. Alkalimat provides an easy to use directory to the very best websites that deal with the African American Experience. The first section covers every aspect of African American history, while a second section deals with a diverse set of topics covering society and culture. Each chapter has a brief essay, extensively annotated on the five best sites for each topic, and then a group of good sites and a short bibliography. This book is designed for a course at the high school or college level. This book should be kept near every home computer that people use to surf the web for Black content. Most people have found out that the major corporations and governments have been the dominant uploaders of information into cyberspace. This volume is different because it is a serious introduction to the full democratic use of the web. These websites will introduce people to the people who are serious about ending the digital divide because they are busy uploading information about the most excluded and marginalized people, the African American community. Many of these sites are being established by Black Studies academic programmes, as well as community based organizations and institutions.
eBook