Research at CISAC

Decreasing Variation in Medical Necessity Decision-Making

CHP/PCOR Project (Completed)
June 25, 1998 - February 25, 1999 and January 1, 1999 - August 31, 1999

Researchers
Alain C. Enthoven (Principal Investigator) - Stanford University
Sara J. Singer - Stanford University
Linda A. Bergthold - Stanford University

The goals of this study are:

to describe for consumers, providers and policymakers how health plans and medical groups (i.e., multi-specialty groups, IPAs, etc.) in California define and use medical necessity in coverage decision making
to understand what works and what does not and to make practical recommendations for change and
to reduce variation and inconsistency in the decision making process.

Funding provided by
• California HealthCare Foundation
• Sierra Health Foundation

Publications

Decreasing Variation in Medical Necessity Decision Making, Appendices
Sara J. Singer, Linda A. Bergthold, Carol Vorhaus, Suzanne Olson, Ian Mutchnick, Ying Ying Goh, Serl Zimmerman, Alain C. Enthoven
California HealthCare Foundation (1999)
Decreasing Variation in Medical Necessity Decision Making
Sara J. Singer, Linda A. Bergthold, C Vorhaus, S Olson, I Mutchnick, YY Goh, S Zimmerman, Alain C. Enthoven
California Health Care Foundation (1999)