12. Health Maintenance Organizations/Health Plans

  1. Brian L. Strom MD, MPH13,14,15,16,
  2. Stephen E. Kimmel MD, MSCE15,16 and
  3. Sean Hennessy PHARMD, PHD15,16
  1. Susan E. Andrade1,2,
  2. Marsha A. Raebel3,4,
  3. Denise Boudreau5,
  4. Robert L. Davis6,
  5. Katherine Haffenreffer7,8,
  6. Pamala A. Pawloski9,
  7. Sengwee Toh10 and
  8. Richard Platt11,12

Published Online: 3 JAN 2012

DOI: 10.1002/9781119959946.ch12

Pharmacoepidemiology, Fifth Edition

Pharmacoepidemiology, Fifth Edition

How to Cite

Andrade, S. E., Raebel, M. A., Boudreau, D., Davis, R. L., Haffenreffer, K., Pawloski, P. A., Toh, S. and Platt, R. (2012) Health Maintenance Organizations/Health Plans, in Pharmacoepidemiology, Fifth Edition (eds B. L. Strom, S. E. Kimmel and S. Hennessy), Wiley-Blackwell, Oxford, UK. doi: 10.1002/9781119959946.ch12

Editor Information

  1. 13

    George S. Pepper Professor of Public Health and Preventive Medicine, Philadelphia, PA, USA

  2. 14

    Department of Biostatistics and Epidemiology, Philadelphia, PA, USA

  3. 15

    Center for Clinical Epidemiology and Biostatistics, Philadelphia, PA, USA

  4. 16

    Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA

Author Information

  1. 1

    Meyers Primary Care Institute, MA, USA

  2. 2

    University of Massachusetts Medical School, Worcester, MA, USA

  3. 3

    Institute for Health Research, Kaiser Permanente Colorado, USA

  4. 4

    University of Colorado at Denver, Denver, CO, USA

  5. 5

    Group Health Research Institute, Seattle, WA, USA

  6. 6

    Center for Health, Research—Southeast, Kaiser Permanente Georgia, Atlanta, GA, USA

  7. 7

    Harvard Pilgrim Health Care Institute, MA, USA

  8. 8

    Department of Population Medicine, Harvard Medical School, Boston, MA, USA

  9. 9

    HealthPartners Research Foundation, Bloomington, MN, USA

  10. 10

    Department of Population Medicine, Harvard Medical School and Harvard, Pilgrim Health Care Institute, Boston, MA, USA

  11. 11

    Department of Population Medicine, Harvard Medical School, MA, USA

  12. 12

    Harvard Pilgrim Health Care Institute, Boston, MA, USA

Publication History

  1. Published Online: 3 JAN 2012
  2. Published Print: 17 FEB 2012

ISBN Information

Print ISBN: 9780470654750

Online ISBN: 9781119959946

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Keywords:

  • comparative effectiveness;
  • consortia;
  • distributed data;
  • drug safety;
  • electronic medical record;
  • health maintenance organization;
  • managed care;
  • observational data;
  • population-based

Summary

Health maintenance organizations, often also referred to as health plans, typically include most of the following: (i) responsibility for the care for a defined population; (ii) information about most diagnoses and procedures resulting from care delivered in both ambulatory and inpatient settings, access to full medical records, and outpatient pharmacy dispensing data; and (iii) the ability to interact with providers and members/ patients. HMOs with these attributes are well positioned to make extensive use of routinely collected electronic data, including both administrative claims and electronic health record data, to perform an array of record linkage studies, such as traditional cohort, nested case–control, and case-based studies. Researchers are also often able to supplement this information with full text record review, and to obtain additional information from providers and patients.

In this chapter, we describe the interplay of health-care systems, operational principles, capabilities, expertise, and data resources that support research across multiple therapeutics areas. Examples are drawn from the HMO Research Network and the Kaiser Permanente Comparative Effectiveness and Safety Research initiative, which are partially overlapping consortia of health plans that exemplify many of these characteristics.