Do managed care plans' tiered networks lead to inequities in care for minority patients?

This study examined whether specialists designated as meeting efficiency thresholds in an insurance company's performance network were less likely than non-designated specialists to treat minority patients insured by that company. Claims data were used to identify patients treated by specialists. Claimants' race/ethnicity status was self-reported to the insurer at enrollment. In large part, minority patients appeared to be evenly distributed across the performance network, with the exception of Asian/Pacific Islanders, who appeared to be more likely to be treated by nondesignated physicians than by designated "good-performing" specialists.

The effect of consumer-directed health plans on the use of preventive and chronic illness services.

We compared use of preventive, cancer screening, and diabetic monitoring services among 17,411 people who were continuously enrolled in a consumer-directed health plan (CDHP) for three years with a matched group of 128,444 people who were enrolled in a preferred provider organization (PPO). In the CDHPs, preventive and screening services were free. Levels and trends in use were similar between the two groups over the three years of follow-up. These results support varying the degree of cost sharing for services depending on the effect of the service on future health status and costs.

Depression and caregiver burden among rural elder caregivers.

Family caregivers of older adults frequently experience feelings of burden and depression though they may not come to the attention to health and service providers until they are at a point of crisis. Through a simple screening tool, the Maine Primary Partners in Caring (MPPC) project identified individuals providing care to older adults through rural primary care practices, in order to provide upstream interventions before caregivers were in crisis. This paper describes a sample (n=62) of rural family caregivers identified through their physicians' offices. High levels of caregiver burden and depression were reported. Family support and knowledge of caregiver tasks predicted decreased caregiver burden and depression, while isolation predicted increased caregiver burden. Implications of these results for gerontological social workers are outlined.

Early intervention screening for family caregivers of older relatives in primary care practices: establishing a community health service alliance in rural America.

The Maine Primary Partners in Caregiving project provides a prime example of how disparate community health, social service, and higher education institutions can build a successful rural service alliance for the purposes of screening for family members experiencing stress during the provision of care to impaired older relatives. Community primary care practices are featured as prime sites for the early identification of elder caregivers experiencing stress and burden. Initial project results and implementation challenges as well as recommended strategies for nurturing such community partnerships are presented.