Health Care Financing Review

Publication covering business and finance issues in the health care industry.

Articles from Vol. 27, No. 1, Fall

Administrator's Decisions
Under Section 1878(f) of the Social Security Act, as amended, a Provider Reimbursement Review Board (PRRB) decision is final unless the Secretary of Health and Human Services, on his own motion, and within 60 days after the provider is notified of...
Care Management in Germany and the U.S.: An Expanded Laboratory
INTRODUCTION Like many industrialized nations, the U.S. and Germany are asking how best to address the growing burden of chronic disease in the context of rising health care costs. The combination of expensive new drugs and diagnostic technologies...
Case Study of American Healthways' Diabetes Disease Management Program
INTRODUCTION For many years there has been escalating concern over the substantial difference between how health care should be delivered to achieve the best possible outcomes and how it is actually delivered. The magnitude of this variance in care...
Continuous Case Management of a German Statutory Health Insurance
INTRODUCTION A serious or chronic illness often turns life upside down. To give support to insured patients, TK, one of the major statutory health insurances in Germany, established in 1990 a special service, the TK CCM. TK-insured persons who are...
First German Disease Management Program for Breast Cancer
BACKGROUND A breast cancer scandal broke in the 1990s in the city of Essen, North-Rhine (1), Germany (Koch, 2000). Qualifications of a local pathologist came into question after a review of the clinical histories of 76 patients revealed recurring...
Germany's Disease Management Program: Improving Outcomes in Congestive Heart Failure
INTRODUCTION Hospital admissions among patients with CHF are a major contributor to health care costs. For this reason, ArztPartner almeda (1) developed a CHF disease management program. The program's aims were to make up deficits in health care...
Managing Chronic Conditions for Elderly Adults: The VNS CHOICE Model
MANAGING CHRONIC ILLNESS For many frail older adults, the need for medical and LTC services are intertwined. The very factors that prompt the need for medical care often drive the need for supportive LTC services. Adequately addressing both requires...
Physician Involvement in Disease Management as Part of the CCM
INTRODUCTION Deficiencies in the care of patients with chronic conditions loom large as key challenges for American health care (Institute of Medicine, 2001). No population is more challenged by chronic conditions than the elderly, and CCI-I under...
PRO DEM: A Community-Based Approach to Care for Dementia
BACKGROUND Early in 1998 a number of physicians in Stuhr and Weyhe (a region south of the City of Bremen with 80,000 inhabitants) decided to work more closely together. They negotiated an integrated contract of care with a statutory health insurance...
U.S. and German Case Studies in Chronic Care Management: An Overview
OVERVIEW The differences between the U.S. health care system and those of other industrialized countries are well established, but attention primarily has focused on the higher level of spending in the U.S., the reasons that the U.S. spends more,...