Arnold Milstein

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CONTEXT Evidence exists that high-volume hospitals (HVHs) have lower mortality rates than low-volume hospitals (LVHs) for certain conditions. However, few employers, health plans, or government programs have attempted to increase the number of patients referred to HVHs. OBJECTIVES To determine the difference in hospital mortality between HVHs and LVHs for(More)
We examine how an integrated delivery system responded to threatened exclusion from an insurer's high-performance network by attempting to reduce costs through fundamental redesign of care processes. Some factors facilitating this transformation, such as its structure as a large salaried medical group exclusively affiliated with a hospital, might be(More)
We obtained price and quality information for nonurgent coronary artery bypass graft (CABG) surgery from a sample of internationally patronized hospitals in low-wage countries. We found rising quality standards, availability of U.S.-trained physicians, and prices far below insurer-negotiated U.S. prices. The price differentials easily accommodated the(More)
OBJECTIVE To evaluate the impact of offering US$100 each to patients and their obstetricians or midwives for timely and comprehensive prenatal care on low birth weight, neonatal intensive care admissions, and total pediatric health care spending in the first year of life. DATA SOURCES/STUDY SETTING Claims and enrollment profiles of the predominantly(More)
It is unclear whether public reporting of hospital and physician performance has improved outcomes for the conditions being reported. We studied the effect of intensive public reporting on hospital mortality for 6 high-frequency, high-mortality medical conditions. Patients in Pennsylvania were matched to patients in other states with varying public(More)
OBJECTIVES To assess the extent to which excluding physicians from a preferred provider organization (PPO) network causes patients to discontinue using their services and whether the associated changes will result in greater demand for emergency department or inpatient care. STUDY DESIGN Analysis of a natural experiment involving the narrowing of a PPO(More)
OBJECTIVE The purpose of this study was to determine whether multidisciplinary team-based care guided by the chronic care model can reduce medical payments and improve quality for Medicaid enrollees with diabetes. RESEARCH DESIGN AND METHODS This study was a difference-in-differences analysis comparing Medicaid patients with diabetes who received(More)
The business case for health insurance coverage of smoking cessation treatments by employers is a strong one. Smoking is one of the nation's costliest health problems, in both human and financial terms. The science behind smoking cessation treatment and promotion of treatment is strong; the cost effectiveness of smoking cessation treatment is among the(More)
INTRODUCTION Coronary artery bypass graft (CABG) surgery is a well-established, commonly performed treatment for coronary artery disease--a disease that affects over 10% of US adults and is a major cause of morbidity and mortality. In 2005, the mean cost for a CABG procedure among Medicare beneficiaries in the USA was $32, 201 ± $23,059. The same operation(More)