Health care costs (21 - 30 of 541 items)
Defense Health Care: US Family Health Plan is Duplicative and Should be Eliminated
GAO-14-684: Published: Jul 31, 2014. Publicly Released: Jul 31, 2014.
The role of the US Family Health Plan (USFHP) within the Department of Defense's (DOD) current military health system (MHS) is duplicative because it offers military beneficiaries the same TRICARE Prime benefit that is offered by the regional TRICARE managed care support contractors (MCSC). The USFHP is an association of six health care providers, referred to as designated providers, which took ow...
Medicaid: Assessment of Variation among States in Per-Enrollee Spending
GAO-14-456: Published: Jun 16, 2014. Publicly Released: Jul 16, 2014.
Estimates of Medicaid spending developed from Centers for Medicare & Medicaid Services (CMS) data sources suggest wide variation among states in Medicaid spending per enrollee, overall and for each of four main eligibility groups—children, adults, disabled, and aged.Estimated Medicaid Spending per Enrollee, by State, Federal Fiscal Year 2008Notes: Spending per enrollee includes federal and state...
Private Health Insurance: Early Effects of Medical Loss Ratio Requirements and Rebates on Insurers and Enrollees
GAO-14-580: Published: Jul 10, 2014. Publicly Released: Jul 10, 2014.
The Patient Protection and Affordable Care Act (PPACA) established federal minimum medical loss ratio (MLR) standards for the percentage of premiums private insurers must spend on their enrollees' medical care claims and activities to improve health care quality, as opposed to what they spend on administrative (“non-claims”) costs. Insurers report to the Centers for Medicare & Medicaid Service...
VA Spina Bifida Program: Outreach to Key Stakeholders and Written Guidance for Claims Audit Follow-up Activities Needed
GAO-14-564: Published: Jun 23, 2014. Publicly Released: Jun 23, 2014.
The Department of Veterans Affairs' (VA) Veterans Health Administration (VHA) provides information and updates on covered health care services to beneficiaries enrolled in its spina bifida program, but has conducted limited outreach with key stakeholder organizations. VHA provides information on health care benefits to enrolled beneficiaries through the program website, for example. However, VHA h...
Medicare: Certain Physician Feedback Reporting Practices of Private Entities Could Improve CMS's Efforts
GAO-14-279: Published: Mar 26, 2014. Publicly Released: Mar 26, 2014.
Private entities GAO reviewed for this study selected a range of measures and benchmarks to assess physician group performance, and provided feedback reports to physicians more than once a year. Private entities almost exclusively focused their feedback efforts on primary care physician groups participating in medical homes and accountable care organizations, which hold physicians responsible for...
Electronic Health Records: HHS Strategy to Address Information Exchange Challenges Lacks Specific Prioritized Actions and Milestones
GAO-14-242: Published: Mar 24, 2014. Publicly Released: Mar 24, 2014.
Providers and stakeholders GAO interviewed in four states with ongoing electronic health information exchange efforts cited key challenges to exchange, in particular, issues related to insufficient standards, concerns about how privacy rules can vary among states, difficulties in matching patients to their records, and costs associated with exchange. Officials from the Centers for Medicare & Medic...
Defense Health Care: Acquisition Process for TRICARE's Third Generation of Managed Care Support Contracts
GAO-14-195: Published: Mar 7, 2014. Publicly Released: Mar 7, 2014.
The TRICARE Management Activity (TMA) within the Department of Defense (DOD) used the acquisition process prescribed by federal regulations to acquire health care services for the TRICARE Program through the third generation of TRICARE's managed care support contracts (MCSC). This process included a three-phased contract award process outlined in the figure below.TMA's Contract Award Process: Phas...
Medicare Advantage: Special Needs Plans Were More Profitable, on Average, than Plans Available to All Beneficiaries in 2011
GAO-14-210R: Published: Dec 19, 2013. Publicly Released: Jan 22, 2014.
Special needs plans (SNP) reported having higher profit margins and spending a lower percentage of total revenues on medical expenses, on average, than Medicare Advantage (MA) plans available to all beneficiaries in 2011. For instance, SNPs' average profit margin was 4.0 percentage points higher than plans available to all beneficiaries--8.6 percent vs. 4.6 percent. SNPs also had a higher plan-lev...
National Preparedness: HHS Is Monitoring the Progress of Its Medical Countermeasure Efforts but Has Not Provided Previously Recommended Spending Estimates
GAO-14-90: Published: Dec 27, 2013. Publicly Released: Dec 27, 2013.
The Department of Health and Human Services (HHS) has established timelines and milestones for the 72 Public Health Emergency Medical Countermeasures Enterprise (PHEMCE) priorities--33 activities, 25 threat-based approaches, and 14 capabilities--that HHS selected as key to fulfilling PHEMCE strategic goals. However, HHS has not made spending estimates for its medical countermeasure development or...
Federal Employees Health Benefits Program: Oversight of Carriers' Fraud and Abuse Programs
GAO-14-39: Published: Nov 14, 2013. Publicly Released: Dec 16, 2013.
The Office of Personnel Management (OPM) Healthcare & Insurance--Federal Employee Insurance Operations office, which we refer to as OPM's contracting office, monitors Federal Employees Health Benefits Program (FEHBP) carriers' compliance with requirements and other guidance for preventing, detecting, and eliminating fraud and abuse. These requirements include establishing a program to assess vulne...