This Article Full Text (PDF) References Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Alert me to new issues of the journal Add to Saved Citations Download to citation manager Request Permissions Request Reprints Add to My Marked Citations Citing Articles Citing Articles via Google Scholar Citing Articles via Scopus Google Scholar Articles by Smith, D. G. Articles by Scanlon, D. P. Search for Related Content PubMed Articles by Smith, D. G. Articles by Scanlon, D. P. Social Bookmarking                         What's this?

Covered Lives in PPOs

University of Michigan

Dennis P. Scanlon

Pennsylvania State University

Many measures of health plan performance require a count of covered lives to make the results meaningful. For both organizational and economic reasons, many preferred provider organizations (PPOs) do not collect enrollment data. Enrollment can be estimated, but current techniques for estimating enrollment are quite imprecise. Imprecision introduces considerable uncertainty into measures of PPO performance. Furthermore, uncertainty may exist even when enrollment data are available and complete because of challenges that PPOs face in linking enrollment data to claims and administrative data. Efforts to increase accountability through performance reporting may require PPOs to devote additional resources for the collection and management of enrollment data. The authors describe practices in tracking enrollment in PPOs and provide data to illustrate variations at both the regional and company levels. Variations in tracking dependents and lack of information on the demographic characteristics of PPO subscribers affect a PPO’s ability to produce standardized performance measures comparable to health maintenance organization performance measures.

Medical Care Research and Review, Vol. 58, No. 4 suppl, 16-33 (2001)
DOI: 10.1177/1077558701584003


CiteULike    Complore    Connotea    Del.icio.us    Digg    Reddit    Technorati    Twitter    What's this?