Beneficiaries (41 - 50 of 107 items)
Medicare HMO Institutional Payments: Improved HCFA Oversight, More Recent Cost Data Could Reduce Overpayments
HEHS-98-153: Published: Sep 9, 1998. Publicly Released: Oct 13, 1998.
Pursuant to a congressional request, GAO reviewed the Health Care Financing Administration's (HCFA) oversight of Medicare payments to health maintenance organizations (HMO) for institutionalized beneficiaries, focusing on: (1) the criteria HCFA uses to determine a beneficiary's institutional status; (2) the methods HCFA employs to ensure that HMOs properly classify beneficiaries as institutionaliz...
Defense Health Care: Fully Integrated Pharmacy System Would Improve Service and Cost-Effectiveness
HEHS-98-176: Published: Jun 12, 1998. Publicly Released: Jun 12, 1998.
Pursuant to a legislative requirement, GAO reviewed the Department of Defense's (DOD) pharmacy programs, focusing on the: (1) adequacy of the information that DOD and its contractors have to manage the pharmacy benefit; (2) merits and feasibility of DOD and its contractors applying commercial best practices, including a uniform formulary, in managing its pharmacy programs; (3) merits and limitatio...
Defense Health Care: Operational Difficulties and System Uncertainties Pose Continuing Challenges for TRICARE
T-HEHS-98-100: Published: Feb 26, 1998. Publicly Released: Feb 26, 1998.
GAO discussed the status of the Department of Defense's (DOD) implementation of its managed health care program, TRICARE, focusing on: (1) DOD's progress in implementing TRICARE; (2) whether DOD is adequately assessing TRICARE'S effects on military health care access, quality, and cost; and (3) the implications of ongoing and proposed changes in the military health care system itself for TRICARE's...
Rural Primary Care Hospitals: Experience Offers Suggestions for Medicare's Expanded Program
HEHS-98-60: Published: Feb 23, 1998. Publicly Released: Feb 23, 1998.
Pursuant to a legislative requirement, GAO reviewed the Rural Primary Care Hospital (RPCH) Program, focusing on: (1) assessing compliance with the requirements that RPCHs have an average length of stay of 72 hours or less and that physicians certify that inpatients are expected to be discharged within 72 hours; (2) assessing whether these two requirements affected the type of patients treated by R...
Medicare: Fewer and Lower Cost Beneficiaries With Chronic Conditions Enroll in HMOs
HEHS-97-160: Published: Aug 18, 1997. Publicly Released: Sep 15, 1997.
Pursuant to a congressional request, GAO examined a mature managed care market to determine: (1) the extent to which Medicare beneficiaries with chronic conditions enroll in health maintenance organizations (HMO); (2) whether beneficiaries with chronic conditions who enroll in HMOs are as costly as those remaining in fee-for-service (FFS) Medicare; and (3) whether beneficiaries with chronic condit...
Medicare and Medicaid: Meeting Needs of Dual Eligibles Raises Difficult Cost and Care Issues
T-HEHS-97-119: Published: Apr 29, 1997. Publicly Released: Apr 29, 1997.
Pursuant to a congressional request, GAO discussed several issues that arise in financing health care for people known as dual eligibles, Medicare beneficiaries who are also eligible for some form of Medicaid support, focusing on: (1) the health characteristics of those who are eligible for both Medicare and Medicaid and the key structural differences between the two programs that serve this popul...
Medigap Insurance: Alternatives for Medicare Beneficiaries to Avoid Medical Underwriting
HEHS-96-180: Published: Sep 10, 1996. Publicly Released: Sep 10, 1996.
Pursuant to a legislative requirement, GAO reviewed Medigap policies, focusing on: (1) the extent to which Medicare beneficiaries are subject to medical underwriting when they change Medigap policies; and (2) options for modifying federal Medigap requirements to ensure that medical underwriting is not a problem in such cases.GAO found that: (1) 11 of the 25 largest Medigap insurers use medical und...
Defense Health Care: New Managed Care Plan Progressing, but Cost and Performance Issues Remain
HEHS-96-128: Published: Jun 14, 1996. Publicly Released: Jun 14, 1996.
Pursuant to a congressional request, GAO reviewed the Department of Defense's (DOD) implementation of its TRICARE managed health care program, focusing on: (1) whether early implementation produced the expected results; (2) how early outcomes may affect costs; and (3) whether DOD is capturing data needed to manage and assess TRICARE performance.GAO found that: (1) early implementation of TRICARE h...
Medicare: Home Health Utilization Expands While Program Controls Deteriorate
HEHS-96-16: Published: Mar 27, 1996. Publicly Released: Apr 3, 1996.
Pursuant to a congressional request, GAO examined the growth in the use of Medicare home health benefits, focusing on the: (1) changes in the home health industry; (2) composition of Medicare home health users; (3) differences in utilization of home health benefits across geographic areas; (4) incentives to overuse Medicare home health benefits; and (5) effectiveness of payment controls in prevent...
Defense Health Care: TRICARE Progressing, but Some Cost and Performance Issues Remain
T-HEHS-96-100: Published: Mar 7, 1996. Publicly Released: Mar 7, 1996.
GAO discussed the Department of Defense's (DOD) implementation of TRICARE, its nationwide managed health care program. GAO noted that: (1) although early TRICARE implementation is basically proceeding as planned, there was some initial beneficiary confusion due to a shortage of adequately trained staff and uncoordinated education and marketing efforts; (2) DOD needs to gather demographic and other...