Association between provider specialty and healthcare costs and glycemic control for patients with diabetes

Aims: To analyze the association between provider, healthcare costs, and glycemic control for patients with diabetes mellitus (DM).

Materials and methods: This cross-sectional study identified adults with type 1 or 2?DM (T1D, T2D) in the Optum database. The main independent variable was provider (endocrinologist or primary care). Regression analysis compared total medical and pharmacy costs, adjusting for health status and other patient differences, by provider.

Results: For all patients, HbA1C improvement was greater, and medical costs significantly lower with an endocrinologist rather than a primary care provider. The largest HbA1C improvement (4%) occurred for insulin-dependent patients seen by endocrinologists. Significant medical savings with endocrinologist management occurred within the Medicare Advantage population in every sub-group of patients, with 14% lower costs ($4,767) for patients with T1D, 11% lower costs ($3,160) for patients with macro- and microvascular complications, and 10% lower costs ($2,237) for insulin-dependent patients. Within the commercial insurance population, medical costs were reduced by ≥9% in every sub-group of patients, with a 20% reduction ($8,450) for patients with micro- and macrovascular complications. Overall total costs (medical and pharmacy) were 8% ($1,541) higher for patients receiving endocrinologist rather than primary care, although endocrinologist care resulted in a 9% reduction (–$3,710) in costs for Medicare Advantage patients with T1D. Total medical costs (excluding pharmacy costs) may be a more accurate indicator of costs associated with patients in various stages of DM.

Limitations: There was insufficient data to develop risk-adjustment payments for pharmacy costs based on disease severity. The cross-sectional design identifies associations and not cause–effect relationships.

Conclusion: DM management by an endocrinologist was associated with greater HbA1C improvement and significantly lower medical costs. Total costs were higher with an endocrinologist, but for patients with T1D lower costs were seen, ranging from 2–9% regardless of insurance type.     

The perceived importance of HR duties to Danish line managers

Today, HR scholars widely acknowledge that realising HRM requires the involvement of all managers and that the personal motivation of line managers plays an important role in their successful involvement. Yet, previous research has neglected to study how line managers rate the importance of particular HR duties and how the importance assigned to HR duties varies across managers. Based on a survey of 1,500 Danish managers, we find that ‘motivating others’ is considered the most important HR duty whereas ‘team building’, ‘handling conflicts’ and ‘coaching’ are considered the least important HR duties. Female top managers in the public sector exhibit the greatest interest in HR whereas men at lower managerial levels in the private sector give lowest priority to HR work. We conclude with possible explanations for the observed differences in a Danish context and beyond and provide suggestions for facilitating managerial involvement in HRM. In doing so we are well aware that the Scandinavian model of HRM in general and the Danish implementation in particular may represent a unique frame for the results.     

The Role of Human Resource Management in Strategy Making

Among the strategy scholars, there is general consensus that responsive‐integrative strategy making is essential for ensuring a competitive advantage in contemporary dynamic environments. What is the role of HR in this process, and how can HR support responsive‐integrative strategy making? To answer these questions, we use illustrative experiences from Chr. Hansen, a global supplier of bioscience‐based ingredients to the food, health, and animal feed industries. We argue that HR's strategic role lies in providing support for both centralized and decentralized strategy making by offering aspirations for strategic decisions and by gathering various sources of inspiration for strategy discussions. © 2013 Wiley Periodicals, Inc.     

A Review on Possible Approaches for Detecting Early Warning Signs in Projects

In this paper, we attempt to provide an overview of the full extent of early warning detection approaches, which are directly or indirectly addressed in the literature. These approaches can aid project managers in taking corrective actions timely enough for preventing failures. The study is based on a review of the current literature within the field of early warning in project management and our own experiences gained from practice. An analysis of the strengths and weaknesses of each approach and their applications in different contexts are also performed. We conclude that the choice of the most effective approach is arguably dependent on the type of project, organizational culture, and the project environment.     

Sri Lanka’s Rural Non-Farm Economy: Removing Constraints to Pro-Poor Growth

We use a survey of rural enterprises from Sri Lanka to explore characteristics of the informal non-farm sector and identify obstacles to its expansion and productivity. Value added in this sector amounts to 80% of agricultural GDP participating households’ incomes are significantly higher than those of households who do not participate. Barriers to entry are low and the impact of non-farm development on inequality modest, implying a large potential contribution to growth and poverty reduction. Infrastructure constraints negatively affect new startups, investment in, and productivity of existing enterprises, with small enterprises being particularly affected.     

Variance-ratio Statistics and High-frequency Data: Testing for Changes in Intraday Volatility Patterns

Variance-ratio tests are routinely employed to assess the variation in return volatility over time and across markets. However, such tests are not statistically robust and can be seriously misleading within a high-frequency context. We develop improved inference procedures using a Fourier Flexible Form regression framework. The practical significance is illustrated through tests for changes in the FX intraday volatility pattern following the removal of trading restrictions in Tokyo. Contrary to earlier evidence, we find nodiscernible changes outside of the Tokyo lunch period. We ascribe the difference to the fragile finite-sample inference of conventional variance-ratio procedures and a single outlier.     

Price dynamics under imperfect information

The paper considers the pricing decision of a monopolist firm having demand and costs exposed to nominal and real shocks which include both permanent and transitory changes. The firm obtains information through both price and quantity signals and the price equation is found by use of a filtering technique. It is shown that imperfect information implies nominal price smoothing where the price adjusts only partially relative to the past price by incorporating new information observed through price and quantity signals.     

Organizational interfaces and innovation: The challenge of integrating supplier knowledge in LEGO systems

Suppliers have become increasingly important as partners in firms' innovation efforts. Reaping potential collaboration benefits is complex due to challenges in combining internal and external knowledge. The paper explores how various types of organizational interfaces between buyer and supplier create both opportunities and problems for their joint actions. The paper is based on a longitudinal case study of attempts to develop an innovative packaging solution for the toy manufacturer LEGO systems. The study shows that buying firms need to carefully analyse what form of organizational interface access to prioritize since each type offers its specific possibilities and drawbacks. Furthermore, the feasibility of organizational interfaces may change over time due to mutual organizational learning.