Managed health care (61 - 70 of 124 items)
Defense Health Care: Lessons Learned from TRICARE Contracts and Implications for the Future
GAO-01-742T: Published: May 17, 2001. Publicly Released: May 17, 2001.
This testimony discusses lessons learned from the Department of Defense's (DOD) TRICARE contracts and their implications for the future. TRICARE's successes and maturity reflect the ability of the DOD and its contractors to work within the current contract structure. However, it has not been easy, and there are important lessons from current contract shortcomings that need to be addressed in desig...
Children With Disabilities: Medicaid Can Offer Important Benefits and Services
T-HEHS-00-152: Published: Jul 12, 2000. Publicly Released: Jul 12, 2000.
Pursuant to a congressional request, GAO discussed the feasibility of allowing some families with children with disabilities to purchase Medicaid coverage, focusing on: (1) what role Medicaid plays in providing health care coverage for children with disabilities; (2) the extent to which private insurance offers coverage of needed services for children with disabilities; and (3) the benefits and se...
Medicare Subvention Demonstration: Enrollment in DOD Pilot Reflects Retiree Experiences and Local Markets
HEHS-00-35: Published: Jan 31, 2000. Publicly Released: Jan 31, 2000.
Pursuant to a legislative requirement, GAO provided information on enrollment in the Department of Defense's (DOD) pilot Medicare health maintenance organization (HMO) for military retirees, focusing on: (1) how successful the demonstration has been in enrolling eligible beneficiaries; (2) what influenced retirees to join DOD's pilot HMOs; and (3) what factors accounted for differences in enrollme...
VA Health Care: VA's Management of Drugs on Its National Formulary
HEHS-00-34: Published: Dec 14, 1999. Publicly Released: Dec 14, 1999.
Pursuant to a congressional request, GAO reviewed how the Department of Veterans' Affairs' (VA) manages its national formulary and how drugs other than those on the formulary are made available to veterans.GAO noted that: (1) VA's national formulary is administered by the Pharmacy Benefits Management Strategic Healthcare Group (PBM), a strategy modeled after one commonly used in private health car...
Medicare + Choice: New Standards Could Improve Accuracy and Usefulness of Plan Literature
HEHS-99-92: Published: Apr 12, 1999. Publicly Released: Apr 13, 1999.
Pursuant to a congressional request, GAO provided information on the Medicare Choice program, focusing on: (1) the extent to which managed care organizations' (MCO) member literature provides beneficiaries with accurate and useful plan information; and (2) whether the Health Care Financing Administration's (HCFA) review process ensures that beneficiaries can rely on MCOs' member literature to make...
Medicare Managed Care: Greater Oversight Needed to Protect Beneficiary Rights
HEHS-99-68: Published: Apr 12, 1999. Publicly Released: Apr 13, 1999.
Pursuant to a congressional request, GAO reviewed Medicare's managed care beneficiary appeals process, focusing on: (1) the appeals process available to beneficiaries when managed care plans deny care or payment for services; (2) beneficiaries' use of the appeals process and the extent to which they are informed of their appeal rights; and (3) the Health Care Financing Administration's (HCFA) over...
Health Insurance for Children: Private Individual Coverage Available, but Choices Can Be Limited and Costs Vary
HEHS-98-201: Published: Aug 5, 1998. Publicly Released: Aug 13, 1998.
Pursuant to a congressional request, GAO reviewed the availability of private sector health coverage for children in the individual insurance market, focusing on: (1) the availability and characteristics of private health insurance products that can be purchased only for a child and how these products differ from other individual private insurance products; (2) the costs of these child-only produc...
Health Services Quality and Public Health Issue Area Plan: Fiscal Years 1999-2000
IAP-98-14: Published: Aug 1, 1998. Publicly Released: Aug 1, 1998.
GAO provided information on its Health Services Quality and Public Health issue area plan for fiscal years 1999 and 2000.GAO plans to: (1) determine whether the public health service agencies are ensuring the public's health and safety efficiently and effectively; (2) identify opportunities for improving the quality of health care under fee-for-service and managed care payment arrangements; (3) id...
Health Plan Quality Information: Efforts to Report on PPO Plan Performance
HEHS-98-213R: Published: Jul 16, 1998. Publicly Released: Jul 16, 1998.
Pursuant to a congressional request, GAO provided information on preferred provider organization (PPO) plan performance, focusing on: (1) large health care purchasers' efforts to collect and disseminate quality performance information about PPO plans; and (2) existing requirements for PPOs to demonstrate quality assurance efforts.GAO noted that: (1) some of the largest health care purchasers in th...
HCFA: Medicare and Medicaid Programs; Hospital Conditions of Participation; Identification of Potential Organ, Tissue, and Eye Donors and Transplant Hospitals' Provision of Transplant-Related Data
OGC-98-58: Published: Jul 7, 1998. Publicly Released: Jul 7, 1998.
Pursuant to a legislative requirement, GAO reviewed the Health Care Financing Administration's (HCFA) new rule on Medicare and Medicaid programs' hospital conditions on participation, identification of potential organ, tissue, and eye donors, and transplant hospitals' provision of transplant-related data. GAO noted that: (1) the rule would: (a) revise current hospital conditions of participation r...