Download or read book Improving the Method Medicare Uses to Pay Health Maintenance Organizations and Competitive Medical Plans written by Joseph P. Newhouse and published by . This book was released on 1988 with total page 16 pages. Available in PDF, EPUB and Kindle. Book excerpt: This paper, the text of a statement before the Subcommittee on Health, U.S. House of Representatives Committee on Ways and Means, March 10, 1988, discusses improving the method Medicare uses to pay health maintenance organizations (HMOs) and competitive medical plans. The author outlines inadequacies in the current payment method--the adjusted average per capita cost (AAPCC)--which is able to explain only about 1 percent of the variations in health care expenditures. In order to achieve an estimated 15 to 20 percent improvement in predictions of cost variations, the author recommends adding adjusters to the formula. The most promising short-term strategy is to introduce measures of utilization into the formula; the most promising step for the mid-term would be to base only a portion of the HMO's reimbursement on an improved AAPCC and base the remainder on the nature of the actual services given an individual.
Download or read book Medicare Managed Care written by Jonathan Bentley Ratner and published by . This book was released on 1995 with total page 32 pages. Available in PDF, EPUB and Kindle. Book excerpt:
Download or read book Improving Accountability in Medicare Managed Care written by United States. Congress. Senate. Special Committee on Aging and published by . This book was released on 1997 with total page 140 pages. Available in PDF, EPUB and Kindle. Book excerpt:
Download or read book Medicare Health Maintenance Organization competitive Medical Plan Manual written by and published by . This book was released on 1989 with total page 308 pages. Available in PDF, EPUB and Kindle. Book excerpt:
Download or read book Medicare written by United States. General Accounting Office and published by . This book was released on 1989 with total page 64 pages. Available in PDF, EPUB and Kindle. Book excerpt:
Download or read book Medicare Managed Care written by United States. Congress. House. Committee on Commerce. Subcommittee on Health and the Environment and published by . This book was released on 1997 with total page 96 pages. Available in PDF, EPUB and Kindle. Book excerpt:
Download or read book Improving the Medicare Market written by Institute of Medicine and published by National Academies Press. This book was released on 1996-11-01 with total page 384 pages. Available in PDF, EPUB and Kindle. Book excerpt: Medicare beneficiaries are rapidly moving into managed care, as attempts to restrain the growth of this costly entitlement program progress. However, advocates for patients question whether the necessary information and structures are in place to enable Medicare consumers to select wisely among private-sector managed care options. Improving the Medicare Market examines how to give Medicare beneficiaries the same choice of health plan options enjoyed in the private sectorâ€"yet protect them as consumers and patients. This book recommends approaches to ensuring accountability and informed purchasing for Medicare beneficiaries in an environment of broader choice and managed careâ€"how the government should evaluate and approve plans, what role the traditional Medicare program should play, how to help to elderly understand their options, and many other practical matters. The committee discusses the information requirements of Medicare beneficiaries and explores in detail how best to respond to their special needs. And it examines the procedures that should be developed to provide the necessary protections for the elderly in a managed care system.
Download or read book Improving Accountability in Medicare Managed Care written by Charles E. Grassley and published by DIANE Publishing. This book was released on 1998-10 with total page 139 pages. Available in PDF, EPUB and Kindle. Book excerpt: Focuses on how Congress & the Administration can provide better information to Medicare beneficiaries when they are trying to select the right health plan to meet their health care needs. Contains statements from U.S. Senate Committee on Aging members as well as testimony from the Medicare Rights Center in New York City, the Institute of Medicine in Stanford, CA, the Health Benefits Service of the California Public Employees Retirement System, & a Medicare beneficiary. Includes General Accounting Office responses to Senate questions on the operations of the Health Care Financing Administration.
Download or read book Medicare HMOs HCFA can promptly eliminate hundreds of millions in excess payments report to the chairman Subcommittee on Health Committee on Ways and Means House of Representatives written by and published by DIANE Publishing. This book was released on with total page 62 pages. Available in PDF, EPUB and Kindle. Book excerpt:
Download or read book Improving the Medicare Market written by Committee on Choice and Managed Care: Assuring Public Accountability and Information for Informed Purchasing by and on Behalf of Medicare Beneficiaries and published by National Academies Press. This book was released on 1996 with total page 392 pages. Available in PDF, EPUB and Kindle. Book excerpt: Improving the Medicare Market examines how to give Medicare beneficiaries the same choice of health plan options enjoyed in the private sector - yet protect them as consumers and patients. This book recommends approaches to ensuring accountability and informed purchasing for Medicare beneficiaries in an environment of broader choice and managed care. It examines how the government should evaluate and approve plans, what role the traditional Medicare program should play, how to help the elderly understand and fairly compare their options, and how to develop the necessary guidelines regarding enrollment, marketing, and grievance procedures.
Download or read book Crossing the Quality Chasm written by Institute of Medicine and published by National Academies Press. This book was released on 2001-08-19 with total page 360 pages. Available in PDF, EPUB and Kindle. Book excerpt: Second in a series of publications from the Institute of Medicine's Quality of Health Care in America project Today's health care providers have more research findings and more technology available to them than ever before. Yet recent reports have raised serious doubts about the quality of health care in America. Crossing the Quality Chasm makes an urgent call for fundamental change to close the quality gap. This book recommends a sweeping redesign of the American health care system and provides overarching principles for specific direction for policymakers, health care leaders, clinicians, regulators, purchasers, and others. In this comprehensive volume the committee offers: A set of performance expectations for the 21st century health care system. A set of 10 new rules to guide patient-clinician relationships. A suggested organizing framework to better align the incentives inherent in payment and accountability with improvements in quality. Key steps to promote evidence-based practice and strengthen clinical information systems. Analyzing health care organizations as complex systems, Crossing the Quality Chasm also documents the causes of the quality gap, identifies current practices that impede quality care, and explores how systems approaches can be used to implement change.
Download or read book Medicare Laboratory Payment Policy written by Institute of Medicine and published by National Academies Press. This book was released on 2000-12-04 with total page 261 pages. Available in PDF, EPUB and Kindle. Book excerpt: Clinical laboratory tests play an integral role in helping physicians diagnose and treat patients. New developments in laboratory technology offer the prospect of improvements in diagnosis and care, but will place an increased burden on the payment system. Medicare, the federal program providing coverage of health-care services for the elderly and disabled, is the largest payer of clinical laboratory services. Originally designed in the early 1980s, Medicare's payment policy methodology for outpatient laboratory services has not evolved to take into account technology, market, and regulatory changes, and is now outdated. This report examines the current Medicare payment methodology for outpatient clinical laboratory services in the context of environmental and technological trends, evaluates payment policy alternatives, and makes recommendations to improve the system.
Download or read book Longshoremen s and Harbor Workers Compensation Act written by and published by . This book was released on 1958 with total page 40 pages. Available in PDF, EPUB and Kindle. Book excerpt:
Download or read book Managing Managed Care written by Institute of Medicine and published by National Academies Press. This book was released on 1997-04-21 with total page 394 pages. Available in PDF, EPUB and Kindle. Book excerpt: Managed care has produced dramatic changes in the treatment of mental health and substance abuse problems, known as behavioral health. Managing Managed Care offers an urgently needed assessment of managed care for behavioral health and a framework for purchasing, delivering, and ensuring the quality of behavioral health care. It presents the first objective analysis of the powerful multimillion-dollar accreditation industry and the key accrediting organizations. Managing Managed Care draws evidence-based conclusions about the effectiveness of behavioral health treatments and makes recommendations that address consumer protections, quality improvements, structure and financing, roles of public and private participants, inclusion of special populations, and ethical issues. The volume discusses trends in managed behavioral health care, highlighting the emerging role of the purchaser. The committee explores problems of overlap and fragmentation in the delivery of behavioral health care and discusses the issue of access, a special concern when private systems are restricted and public systems overburdened. Highly applicable to the larger health care system, this volume will be of particular interest to all stakeholders in behavioral healthâ€"federal and state policymakers, public and private purchasers, health care providers and administrators, consumers and consumer advocates, accrediting organizations, and health services researchers.
Download or read book Pay for Performance in Health Care written by Jerry Cromwell and published by RTI Press. This book was released on 2011-02-28 with total page 388 pages. Available in PDF, EPUB and Kindle. Book excerpt: This book provides a balanced assessment of pay for performance (P4P), addressing both its promise and its shortcomings. P4P programs have become widespread in health care in just the past decade and have generated a great deal of enthusiasm in health policy circles and among legislators, despite limited evidence of their effectiveness. On a positive note, this movement has developed and tested many new types of health care payment systems and has stimulated much new thinking about how to improve quality of care and reduce the costs of health care. The current interest in P4P echoes earlier enthusiasms in health policy—such as those for capitation and managed care in the 1990s—that failed to live up to their early promise. The fate of P4P is not yet certain, but we can learn a number of lessons from experiences with P4P to date, and ways to improve the designs of P4P programs are becoming apparent. We anticipate that a “second generation” of P4P programs can now be developed that can have greater impact and be better integrated with other interventions to improve the quality of care and reduce costs.
Download or read book Administration s Medicare Capitation Initiatives written by United States. Congress. House. Committee on Ways and Means. Subcommittee on Health and published by . This book was released on 1989 with total page 160 pages. Available in PDF, EPUB and Kindle. Book excerpt:
Download or read book Federalism and Health Policy written by Alan Weil and published by The Urban Insitute. This book was released on 2003 with total page 448 pages. Available in PDF, EPUB and Kindle. Book excerpt: The balance between state and federal health care financing for low-income people has been a matter of considerable debate for the last 40 years. Some argue for a greater federal role, others for more devolution of responsibility to the states. Medicaid, the backbone of the system, has been plagued by an array of problems that have made it unpopular and difficult to use to extend health care coverage. In recent years, waivers have given the states the flexibility to change many features of their Medicaid programs; moreover, the states have considerable flexibility to in establishing State Children's Health Insurance Programs. This book examines the record on the changing health safety net. How well have states done in providing acute and long-term care services to low-income populations? How have they responded to financial incentives and federal regulatory requirements? How innovative have they been? Contributing authors include Donald J. Boyd, Randall R. Bovbjerg, Teresa A. Coughlin, Ian Hill, Michael Housman, Robert E. Hurley, Marilyn Moon, Mary Beth Pohl, Jane Tilly, and Stephen Zuckerman.
