Managed Care:
Oregon Program Appears Successful but Expansions Should Be Implemented Cautiously
T-HRD-91-48: Published: Sep 16, 1991. Publicly Released: Sep 16, 1991.
Additional Materials:
- Full Report:
Contact:
GAO discussed Oregon's proposal to expand its prepaid managed care activities as part of a demonstration that would restructure its entire Medicaid program, focusing on the existing managed care program that will serve as the foundation for the proposed demonstration project. GAO noted that: (1) since 1985, Oregon's Medicaid program has increased to an enrollment of about 65,000 and Oregon has contracted with 16 health service providers to provide Medicaid services; (2) all but one of those providers were capitated for physician and outpatient services only; (3) Medicaid clients received inpatient services on a fee-for-service basis; (4) Oregon designed its Medicaid demonstration project to expand Medicaid eligibility to all persons with incomes up to 100 percent of the federal poverty level while redefining the scope of health care services it will reimburse; (5) the project is aimed at providing services through a managed care system that is moving toward full service prepaid health plans capitated to provide inpatient and ambulatory care; (6) Oregon has avoided many problems that other states had experienced by instituting safeguards against inappropriate service delivery and quality and complying with federal quality assurance requirements; and (7) although Oregon anticipates full implementation of the project by 1992, it was unclear whether Oregon could implement the statewide system needed to serve the threefold increase in Medicaid managed care enrollments by 1992.
Jan 14, 2021
-
Medicaid:
Data Completeness and Accuracy Have Improved, Though Not All Standards Have Been MetGAO-21-196: Published: Jan 14, 2021. Publicly Released: Jan 14, 2021.
Jan 4, 2021
-
Medicare Severe Wound Care:
Spending Declines May Reflect Site of Care Changes; Limited Information Is Available on QualityGAO-21-92: Published: Jan 4, 2021. Publicly Released: Jan 4, 2021.
Dec 22, 2020
-
Defense Health Care:
Efforts to Ensure Beneficiaries Access Specialty Care and Receive Timely and Effective CareGAO-21-143: Published: Dec 22, 2020. Publicly Released: Dec 22, 2020.
Dec 16, 2020
-
Medicaid Long-Term Services and Supports:
Access and Quality Problems in Managed Care Demand Improved OversightGAO-21-49: Published: Nov 16, 2020. Publicly Released: Dec 16, 2020.
Dec 14, 2020
-
Drug Pricing Program:
HHS Uses Multiple Mechanisms to Help Ensure Compliance with 340B RequirementsGAO-21-107: Published: Dec 14, 2020. Publicly Released: Dec 14, 2020. -
Substance Use Disorder:
Reliable Data Needed for Substance Abuse Prevention and Treatment Block Grant ProgramGAO-21-58: Published: Dec 14, 2020. Publicly Released: Dec 14, 2020.
Dec 10, 2020
-
Indian Health Service:
Actions Needed to Improve Oversight of Provider Misconduct and Substandard PerformanceGAO-21-97: Published: Dec 10, 2020. Publicly Released: Dec 10, 2020. -
Clinical Labs:
Studies Suggest Biopsy Specimen Misidentification and Contamination Errors Are InfrequentGAO-21-59: Published: Nov 10, 2020. Publicly Released: Dec 10, 2020.
Dec 7, 2020
-
Medicaid:
CMS Needs More Information on States' Financing and Payment Arrangements to Improve OversightGAO-21-98: Published: Dec 7, 2020. Publicly Released: Dec 7, 2020.
Dec 1, 2020
-
Military Health Care:
Defense Health Agency Processes for Responding to Provider Quality and Safety ConcernsGAO-21-160R: Published: Dec 1, 2020. Publicly Released: Dec 1, 2020.
Looking for more? Browse all our products here