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Private Payers Serving Individuals with Disabilities and Chronic Conditions
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Ronald J. Ozminkowski, Ph.D., Mark W. Smith, Ph.D., Rosanna M. Coffey, Ph.D., Tami L. Mark, Ph.D., Cheryl A. Neslusan, Ph.D., and John Drabek, Ph.D.
The MEDSTAT Group
This report was prepared under contract #HHS-100-95-0044 between the U.S. Department of Health and Human Services (HHS), Office of Disability, Aging and Long-Term Care Policy (DALTCP) and the MEDSTAT Group. For additional information about this subject, you can visit the DALTCP home page at http://aspe.hhs.gov/office_specific/daltcp.cfm or contact the ASPE Project Officer, John Drabek, at HHS/ASPE/DALTCP, Room 424E, H.H. Humphrey Building, 200 Independence Avenue, S.W., Washington, D.C. 20201. His e-mail address is: John.Drabek@hhs.gov.
The opinions and views expressed in this report are those of the authors. They do not necessarily reflect the views of the Department of Health and Human Services, the contractor or any other funding organization.
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I. INTRODUCTION
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II. INDEMNITY INSURANCE AND MANAGED CARE FOR PEOPLE WITH DISABILITIES
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III. OPERATIONAL MEASUREMENT OF CHRONIC ILLNESS AND POTENTIAL DISABILITY FOR THE PRIVATE PAYERS STUDY
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IV. RESEARCH OVERVIEW: FOUR STUDIES OF MANAGED CARE FOR PEOPLE WITH POTENTIALLY DISABLING CHRONIC CONDITIONS
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V. CHARACTERISTICS OF PEOPLE WITH POTENTIALLY DISABLING CHRONIC CONDITIONS IN INDEMNITY AND MANAGED CARE PLANS
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VI. THE IMPACT OF MANAGED CARE ON UTILIZATION AND EXPENDITURES OF PEOPLE WITH POTENTIALLY DISABLING CHRONIC CONDITIONS
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VII. RISK-ADJUSTMENT FOR PEOPLE WITH POTENTIALLY DISABLING CHRONIC CONDITIONS
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VIII. RISK-ADJUSTMENT OF CAPITATION PAYMENTS TO BEHAVIORAL HEALTH CARE CARVE-OUTS: HOW WELL DO EXISTING METHODOLOGIES ACCOUNT FOR PSYCHIATRIC DISABILITY?
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REFERENCES
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NOTES
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APPENDIX A: Diagnosis Codes Associated with Potentially Disabling Conditions
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APPENDIX B: Characteristics and Service Utilization By Plan Type
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APPENDIX C: Statistical Analyses
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APPENDIX D: Least-Squares Regressions
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