Health plan (HMO, PPO, etc.)
Supported by a central data repository, a statewide managed care plan for children and young adults in foster care provides ongoing care coordination, linkages to community-based services, and psychotropic drug utilization reviews, leading to better care access, better followup after mental illness hospitalization, and less use of psychotropic drugs.
A jointly governed consortium of more than 100 local organizations, the Milwaukee Enrollment Network helps county residents (particularly low-income and uninsured individuals) learn about and enroll in public and private health insurance plans.
Daily automated text messages combined with nurse followup improved self-management behaviors among patients with diabetes, leading to significant improvements in glycemic control, fewer doctor visits, lower costs, and high patient satisfaction.
Funded by and receiving referrals from the various public systems serving at-risk youth, Wraparound Milwaukee pays for and supports the provision of coordinated mental health and support services to children and adolescents with serious emotional and mental health needs, leading to less institutionalization and recidivism, lower costs, increased school attendance, better functioning at home and in school, and high satisfaction.
The California Public Employees' Retirement System generated significant cost savings by adopting reference pricing for hip and knee replacement procedures, causing enrollees to migrate to high-value facilities and encouraging high-price hospitals to lower their fees.
A statewide health information exchange provides health plans and accountable care organizations with daily alerts on patients visiting the emergency department or being admitted to an inpatient facility, allowing them to take steps to curb use of these high-cost venues and replace them with lower-cost primary care visits.
The combination of a small financial incentive and patient education leads to a modest, short-lived increase in physician visits, but has no effect on blood pressure control or on racial and ethnic disparities in management and control of hypertension.
The Oregon Health Authority (which oversees the State Medicaid program) initiated a series of policy changes to promote earlier detection, more effective referrals, and better coordination of care for pediatric patients with developmental delays, leading to a significant increase in screening rates and enhanced access to early intervention services.
A Medicaid health plan uses a range of direct and indirect information sources to collect accurate data on race, ethnicity, and preferred language for a high proportion of members.
The State of Connecticut offers employees, retirees, and dependents significant financial incentives to access appropriate care and engage in their health, leading to high participation rates, more appropriate utilization of health care resources, better medication adherence, and slower growth in costs.