Health care services (81 - 90 of 1,007 items)
VA Health Care: Actions Needed to Improve Administration and Oversight of Veterans' Millennium Act Emergency Care Benefit
GAO-14-175: Published: Mar 6, 2014. Publicly Released: Mar 6, 2014.
The Veterans Millennium Health Care and Benefits Act (Millennium Act) authorizes the Department of Veterans Affairs (VA) to cover emergency care for conditions not related to veterans' service-connected disabilities when veterans who have no other health plan coverage receive care at non-VA providers. However, GAO identified a number of instances where VA staff who processed claims did not comply...
Electronic Health Records: VA and DOD Need to Support Cost and Schedule Claims, Develop Interoperability Plans, and Improve Collaboration
GAO-14-302: Published: Feb 27, 2014. Publicly Released: Feb 27, 2014.
The Departments of Veterans Affairs (VA) and Defense (DOD) abandoned their plans to develop an integrated electronic health record (iEHR) system and are instead pursuing separate efforts to modernize or replace their existing systems in an attempt to create an interoperable electronic health record. Specifically, in February 2013, the secretaries cited challenges in the cost and schedule for devel...
Military Health System: Sustained Senior Leadership Needed to Fully Develop Plans for Achieving Cost Savings
GAO-14-396T: Published: Feb 26, 2014. Publicly Released: Feb 26, 2014.
Department of Defense (DOD) senior leadership has demonstrated a commitment to oversee implementation of its military health system’s (MHS) reform and has taken a number of actions to enhance the reform efforts. For example, in March 2013, DOD chartered the MHS Governance Transition Organization to provide oversight, management, and support for the implementation. This entity is chartered to exi...
Medicaid: Demographics and Service Usage of Certain High-Expenditure Beneficiaries
GAO-14-176: Published: Feb 19, 2014. Publicly Released: Feb 19, 2014.
In fiscal year 2009, states spent nearly a third (31.6 percent) of all Medicaid expenditures on the most expensive Medicaid-only beneficiaries, who were 4.3 percent of total Medicaid beneficiaries. States spent another third (33.1 percent) on all other Medicaid-only beneficiaries, who represented 81.2 percent of total Medicaid beneficiaries. Among dual eligible beneficiaries, a similar pattern exi...
Medicare Advantage: 2011 Profits Similar to Projections for Most Plans, but Higher for Plans with Specific Eligibility Requirements
GAO-14-148: Published: Dec 19, 2013. Publicly Released: Jan 22, 2014.
Medicare Advantage (MA) organizations' actual medical expenses, nonmedical expenses (such as marketing, sales, and administration) and profits as a percentage of total revenue were, on average, similar to projected values for plans available to all beneficiaries in 2011, the most recent year for which data were available at the time of the request for this work. MA organizations' actual medical ex...
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...
Medicare: Continuous Insurance before Enrollment Associated with Better Health and Lower Program Spending
GAO-14-53: Published: Dec 17, 2013. Publicly Released: Jan 16, 2014.
Beneficiaries with continuous health insurance coverage for approximately 6 years before enrolling in Medicare were more likely than those without prior continuous insurance to report being in good health or better during the first 6 years in Medicare. In particular, having prior continuous insurance raised the predicted probability that a beneficiary reported being in good health or better by nea...
Children's Health Insurance: Information on Coverage of Services, Costs to Consumers, and Access to Care in CHIP and Other Sources of Insurance
GAO-14-40: Published: Nov 21, 2013. Publicly Released: Dec 20, 2013.
In five selected states, GAO determined that the separate State Children's Health Insurance Program (CHIP) plans were generally comparable to the benchmark plans selected by states in 2012 as models for the benefits that will be offered through qualified health plans (QHP) in 2014. The plans were comparable in the services they covered and the services on which they imposed limits, although there...
VA Nursing Homes: Reporting More Complete Data on Workload and Expenditures Could Enhance Oversight
GAO-14-89: Published: Dec 20, 2013. Publicly Released: Dec 20, 2013.
In fiscal year 2012, the Department of Veterans Affairs' (VA) nursing home workload--the average number of veterans receiving nursing home care per day--was 36,250 across all of the three nursing home settings in which VA provided or paid for veterans' nursing home care. The three settings include Community Living Centers (CLCs), which are VA-owned and operated; community nursing homes with which...
Indian Health Service: Opportunities May Exist to Improve the Contract Health Services Program
GAO-14-57: Published: Dec 11, 2013. Publicly Released: Dec 11, 2013.
For Indian Health Service (IHS) contract health services (CHS) delivered in fiscal year 2011, a majority of claims were paid within 6 months of the service delivery date, but some took much longer. Specifically, about 73 percent of claims were paid within 6 months of service delivery, while about 8 percent took more than 1 year. The CHS payment process consists of three main steps: (1) the local C...