Remodeling Home Care: Making the Transition from Fee-for-Service to Managed Care

by Rappaport,Meryl Beth

• ISBN13: 9780815334408
• ISBN10: 0815334400
• Format: Hardcover
• Copyright: 1999-12-01
• Publisher: Routledge

Summary

The driving influence of managed care and cost containment is causing home care organizations to reconceptualize their roles in the health care delivery system while stimulating massive changes in agency structure, operations, and services. Medicare-certified home health agencies, which have flourished under a per-visit, fee-for-service reimbursement model, are increasingly delivering care under managed care reimbursement models. Conducted at this pivotal point in time, the book examines the intersection of two rapidly growing health care sectors: home health and managed care. The environment surrounding the transition from traditional reimbursement to managed care is uncertain and rapidly changing. Strategies organizations are using to cope with this uncertainty and HHA administrators' perceptions of the two greatest impacts of managed care are described. Despite considerable variation in agency characteristics, more similarities than differences are found among HHAs. The research concludes thatmarket and environment pressures within heavily HMO-penetrated communities encourage all HHAs to become similar, regardless of whether the HHAs have managed care contracts.

Table of Contents

Preface

Acknowledgments

Tables and Figures

Introduction

Organizational and Management Responses to Competition

Significance of the Study

Review of the Literature

Home Care Agencies in the United States

A Brief History of Home Care's Evolution

The Changing Reimbursement Environment for Home Care

Variations in Home Health Utilization

Utilization, Access, Outcomes and Cost Effectiveness

Fragmentation in the Structure of Home Care Services

DME and Home Infusion

Managed Care and Home Care

Economics and Home Care

Organizational Theory and Home Care

Organizational Structure

Organizational Relationships

Organizational Stability and Change

Summary

Methodology

Aim

Research Question and Hypotheses

Study Population and Data Sources

Sampling Procedures

Types and Sources of Data

Validation

Data Collection Issues

Method of Analysis

Summary

Findings

Financial Issues

Agency Characteristics and Structure

Services and Utilization

Management and Operations

Summary

Study Conclusions and Implications

Overview

Study Participants and Data Issues

Summary, Discussion and Research Agenda for Four Key Areas

Financial Issues

Agency Characteristics and Structure

Services and Utilization

Management and Operations

Policy Implications and Future Research

Note

Appendices

References

Index

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