Managed health care (81 - 90 of 203 items)
Medicare and Medicaid: Implementing State Demonstrations for Dual Eligibles Has Proven Challenging
HEHS-00-94: Published: Aug 18, 2000. Publicly Released: Sep 18, 2000.
Pursuant to a congressional request, GAO reviewed states' initiatives to enroll dual eligibles (beneficiaries who qualify for both Medicare and Medicaid benefits) into one managed care plan, focusing on: (1) the status and key features of state initiatives focusing on: (1) the status and key features of state initiatives to integrate care for dual-eligible beneficiaries; and (2) factors that have...
Medicare+Choice: Plan Withdrawals Indicate Difficulty of Providing Choice While Achieving Savings
HEHS-00-183: Published: Sep 7, 2000. Publicly Released: Sep 7, 2000.
Pursuant to a congressional request, GAO reviewed health care plans' withdrawal from the Medicare Choice program, focusing on the: (1) geographic distribution and the distribution among plans of enrollees affected by the recent plan withdrawals; (2) factors associated with plans that terminated or reduced their participation in the program; and (3) likely role of payment rates in affecting plans'...
Medicare and Managed Care Plans: Payments and Costs for Selected Hospitals
HEHS-00-177R: Published: Sep 1, 2000. Publicly Released: Sep 1, 2000.
Pursuant to a congressional request, GAO reviewed Medicare and managed care plan hospital costs and payments, focusing on: (1) the relationship between Medicare and managed care plan payments and costs; (2) managed care plan payments and the relative importance of managed care business; and (3) Medicare and managed care plan payments and costs by hospital teaching status.GAO noted that: (1) for th...
Medicare+Choice: Payments Exceed Cost of Fee-for-Service Benefits, Adding Billions to Spending
HEHS-00-161: Published: Aug 23, 2000. Publicly Released: Aug 23, 2000.
Pursuant to a congressional request, GAO reviewed Medicare Choice program payment issues, focusing on: (1) whether program spending for Medicare Choice plan enrollees has exceeded what Medicare-covered care for these beneficiaries would have cost in the fee-for-service (FFS) Medicare program; and (2) the extent to which payments to individual plans differ from expected FFS costs.GAO noted that: (1...
Medicare: Refinements Should Continue to Improve Appropriateness of Provider Payments
T-HEHS-00-160: Published: Jul 19, 2000. Publicly Released: Jul 19, 2000.
Pursuant to a congressional request, GAO discussed the effects of recent Medicare payment reforms, focusing on the Balanced Budget Act of 1997 (BBA) payment reforms affecting home health agencies, skilled nursing facilities (SNF), and the health plans in Medicare's managed care program, known as Medicare Choice.GAO noted that: (1) the reactions by providers serving Medicare beneficiaries to BBA an...
Defense Health Care: Opportunities to Reduce TRICARE Claims Processing and Other Costs
T-HEHS-00-138: Published: Jun 22, 2000. Publicly Released: Jun 22, 2000.
Pursuant to a congressional request, GAO discussed opportunities to reduce claims processing and other costs of the Department of Defense's (DOD) managed health care program--TRICARE, focusing on: (1) the cost of processing TRICARE claims; (2) opportunities that potentially can reduce costs and improve service to beneficiaries, namely increased anti-fraud efforts and more joint procurement of phar...
Health Care Access: Programs for Underserved Populations Could Be Improved
T-HEHS-00-81: Published: Mar 23, 2000. Publicly Released: Mar 23, 2000.
Pursuant to a congressional request, GAO discussed the effectiveness of the Health Resources and Services Administration's (HRSA) two safety-net programs--the Community and Migrant Health Center program and the National Health Service Corps--to improve access to medically underserved populations.GAO noted that: (1) both the health centers and the Corps are important safety-net providers to the nat...
Prescription Drug Benefits: Applying Private Sector Management Methods to Medicare
T-HEHS-00-84: Published: Mar 22, 2000. Publicly Released: Mar 22, 2000.
Pursuant to a congressional request, GAO discussed issues related to a potential Medicare outpatient prescription drug benefit, focusing on: (1) the factors contributing to the rise in prescription drug spending and the impact of the rise in spending on Medicare beneficiaries; (2) the methods private insurers have developed to manage these rising costs; and (3) whether and how Medicare can adapt t...
Defense Health Care: Observations on Proposed Benefit Expansion and Overcoming TRICARE Obstacles
T-HEHS/NSIAD-00-129: Published: Mar 15, 2000. Publicly Released: Mar 15, 2000.
Pursuant to a congressional request, GAO discussed proposed changes and improvements to the military health system (MHS), focusing on: (1) the various proposals to expand the military health care benefit, especially those for older retirees, including describing the nature of the enhancement, the present or potential challenges in implementing these proposals, and overall cost implications; (2) th...
Medicare: HCFA Faces Challenges to Control Improper Payments
T-HEHS-00-74: Published: Mar 9, 2000. Publicly Released: Mar 9, 2000.
Pursuant to a congressional request, GAO discussed the Health Care Financing Administration's (HCFA) efforts to control improper payments in the Medicare program, focusing on the ongoing and emerging challenges HCFA faces in safeguarding Medicare payments.GAO noted that: (1) major information gaps exist in the Medicare program--in both traditional Medicare and Medicare Choice--that impede HCFA's a...