Managed Care

 

Medicare+Choice = Slow Start; Cost, Questionable Return Cited

MANAGED CARE October 1998. © MediMedia USA
Washington Initiatives

Medicare+Choice = Slow Start; Cost, Questionable Return Cited

MANAGED CARE October 1998. ©1998 Stezzi Communications
Washington Initiatives

The Medicare+Choice program is getting out of the gate rather slowly. At press time, the Health Care Financing Administration had received only two applications from groups wanting to establish provider-service organizations and one from a prospective preferred-provider organization — and none at all from insurers offering medical savings accounts.

What's the problem? According to HCFA spokesman Peter Askenaz, it's too early to make any judgments. The regulations were released June 26, Askenaz notes, and it takes time for health care organizations to get the paperwork together to submit to HCFA. Don't rule out possible regulation confusion — after all, the 833-page regulation document isn't exactly light reading. And finally, the decision to become a risk contractor is not one that "organizations should enter into lightly," says Askenaz. "It represents a substantial financial commitment."

Still another factor may be that interested parties are taking a hard look at the less-than-profitable experience some Medicare HMOs have experienced in certain markets, particularly in rural areas.

Currently, Medicare allows beneficiaries to enroll in health maintenance organizations. Medicare+Choice, also called Medicare Part C and a product of the Balanced Budget Act, is designed to provide beneficiaries with the option to enroll in other types of arrangements, such as PSOs and MSAs. Time is running out on the MSA option, however; beneficiaries who want to join must sign up by next month.

After so much hoopla about PSOs, their future is very much up in the air. According to Robert Berenson, director of HCFA's Center for Health Plans and Providers, physician-run organizations may be reluctant to become risk contractors when payment rates do not necessarily promise to support such a bold move.

Meetings

2014 Annual HEDIS® and Star Ratings Symposium Nashville, TN November 3–4, 2014
PCMH & Shared Savings ACO Leadership Summit Nashville, TN November 3–4, 2014
Medicare Risk Adjustment, Revenue Management, & Star Ratings Fort Lauderdale, FL November 12–14, 2014
World Orphan Drug Congress Europe 2014 Brussels, Belgium November 12–14, 2014
Healthcare Chief Medical Officer Forum Alexandria, VA November 13–14, 2014
Home Care Leadership Summit Atlanta, GA November 17–18, 2014
6th Semi-Annual Diagnostic Coverage and Reimbursement Conference Boston December 4–5, 2014
Customer Analytics & Engagement in Health Insurance Chicago December 4–5, 2014
Pharmaceutical and Biotech Clinical Quality Assurance Conference Alexandria, VA December 4–5, 2014
9th Semi-Annual Medical Device Coverage and Reimbursement Conference San Diego December 5, 2014
8th Annual Medical Device Clinical Trials Conference Chicago December 8–9, 2014
HealthIMPACT Southeast Tampa, FL January 23, 2015