James C Vertrees
Biographic Data
| ID | 5539402 |
|---|---|
| NAME | James C Vertrees |
| GIVEN NAMES | James C |
| FAMILY NAME | Vertrees |
| SIGNATURE | VERTREES J C |
| AFFILIATIONS | Yeshiva of Greater Washington |
| VERIFIED | No |
| TOTAL WORKS | 7 |
| TOTAL CITATIONS | 0 |
| AUTHOR COUNT | 7 |
| EDITOR COUNT | 0 |
| FIRST PUBLICATION YEAR | 1984 |
| LATEST PUBLICATION YEAR | 1996 |
| H-INDEX | 0 |
Prior and Current Costs in Capitated Health Plans: The Effects of Health Status at Enrollment
We compared the prior and current costs of persons age 65 and older enrolling in a Social/Health Maintenance Organization in each of four sites with samples of persons using standard Medicare benefits in each site. Analyses were adjusted for individual health differences using case mix scores. Costs were examined in the year before S/HMO enrollment or prior to the sampling of a person using regular Medicare services as well as costs during the st…
Evaluating Long-Term Care Demonstrations in Real Time with Study Design and Plan Performance Interactions
The evaluation of long-term care demonstrations has to deal with complex organizational entities, with large, heterogeneous client populations that, during the course of study, may have to change features of their organization or operation. The implications of such "real-time" changes are discussed for analyses of the operation and performance of Social/Health Maintenance Organizations over a 5-year period (2 years of start-up and enrollment and …
A Method for Adjusting Capitation Payments to Managed Care Plans Using Multivariate Patterns of Health and Functioning: The Experience of Social/Health Maintenance Organizations
A multivariate procedure for identifying case-mix dimensions from discrete health variables is presented. Since the dimensions are generated only from health use data and not service use data, they can be used for adjust capitation rates to provide incentives to treat persons not currently well integrated in standard health care system (e.g., very ill persons, the uninsured) or to promote specific health outcomes. The procedure is illustrated wit…
Changes in Health Service Use and Mortality among U.S. Elderly in 1980-1986
Concern has emerged about the impact on quality of care of recent changes in Medicare reimbursement for acute hospital episodes (i.e., the introduction of the Prospective Payment System based on the Diagnosis Related Groups Reimbursement methodology). One aspect of those concerns is that very sick patients would be prematurely discharged to nursing homes in which the high level of medical care required would not be available. This was recently st…
Controlling Risk in Capitation Payment: Multivariate Definitions of Risk Groups
There are a number of different reimbursement strategies proposed for health maintenance organization (HMO) style health care providers. Each of those strategies is designed to leave the provider at risk to provide incentives for him to increase the efficiency of his organization. Many such systems do not include as underwriting factors the medical status of the patient. Failure to include adjustment for the patient's medical status can: 1) leave…
A Multivariate Approach for Classifying Hospitals and Computing Blended Payment Rates
Prospective payment for inpatient hospital care is based on the ideal that hospitals that produce similar outputs, as measured by the types of cases the hospital treats, should be paid similar prices. However, similar output is a multidimensional concept. Thus operationalization of this ideal will ultimately require a more complex framework for determining hospital payment rates than currently employed at either the federal or state level. This a…
The Use of Grade of Membership Analysis to Evaluate and Modify Diagnosis-related Groups
A classification methodology is presented that can be used to evaluate the heterogeneity of reimbursement categories and service groups in multivariate terms. This methodology, called Grade of Membership analysis, has several properties that are particularly important in such assessments. First, simultaneously with the determination of the multivariate profile of characteristics that describe a group, the methodology determines the degree to whic…
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The Use of Grade of Membership Analysis to Evaluate and Modify Diagnosis-related Groups
A classification methodology is presented that can be used to evaluate the heterogeneity of reimbursement categories and service groups in multivariate terms. This methodology, called Grade of Membership analysis, has several properties that are particularly important in such assessments. First, simultaneously with the determination of the multivariate profile of characteristics that describe a group, the methodology determines the degree to whic…
A Multivariate Approach for Classifying Hospitals and Computing Blended Payment Rates
Prospective payment for inpatient hospital care is based on the ideal that hospitals that produce similar outputs, as measured by the types of cases the hospital treats, should be paid similar prices. However, similar output is a multidimensional concept. Thus operationalization of this ideal will ultimately require a more complex framework for determining hospital payment rates than currently employed at either the federal or state level. This a…
Controlling Risk in Capitation Payment: Multivariate Definitions of Risk Groups
There are a number of different reimbursement strategies proposed for health maintenance organization (HMO) style health care providers. Each of those strategies is designed to leave the provider at risk to provide incentives for him to increase the efficiency of his organization. Many such systems do not include as underwriting factors the medical status of the patient. Failure to include adjustment for the patient's medical status can: 1) leave…
Changes in Health Service Use and Mortality among U.S. Elderly in 1980-1986
Concern has emerged about the impact on quality of care of recent changes in Medicare reimbursement for acute hospital episodes (i.e., the introduction of the Prospective Payment System based on the Diagnosis Related Groups Reimbursement methodology). One aspect of those concerns is that very sick patients would be prematurely discharged to nursing homes in which the high level of medical care required would not be available. This was recently st…
A Method for Adjusting Capitation Payments to Managed Care Plans Using Multivariate Patterns of Health and Functioning: The Experience of Social/Health Maintenance Organizations
A multivariate procedure for identifying case-mix dimensions from discrete health variables is presented. Since the dimensions are generated only from health use data and not service use data, they can be used for adjust capitation rates to provide incentives to treat persons not currently well integrated in standard health care system (e.g., very ill persons, the uninsured) or to promote specific health outcomes. The procedure is illustrated wit…
Evaluating Long-Term Care Demonstrations in Real Time with Study Design and Plan Performance Interactions
The evaluation of long-term care demonstrations has to deal with complex organizational entities, with large, heterogeneous client populations that, during the course of study, may have to change features of their organization or operation. The implications of such "real-time" changes are discussed for analyses of the operation and performance of Social/Health Maintenance Organizations over a 5-year period (2 years of start-up and enrollment and …
Prior and Current Costs in Capitated Health Plans: The Effects of Health Status at Enrollment
We compared the prior and current costs of persons age 65 and older enrolling in a Social/Health Maintenance Organization in each of four sites with samples of persons using standard Medicare benefits in each site. Analyses were adjusted for individual health differences using case mix scores. Costs were examined in the year before S/HMO enrollment or prior to the sampling of a person using regular Medicare services as well as costs during the st…
Healthcare Policy and Management (7 works) · Health care (6 works) · Medicine (6 works) · Economics (5 works) · Actuarial science (4 works) · Business (4 works) · Capitation (4 works) · Payment (4 works) · Capitation fee (3 works) · Computer Science (3 works)