Managed Care

 

Major Managed Medicare Player Plans No Expansion in Next 5 Years

MANAGED CARE October 1999. © MediMedia USA
News and Commentary

Major Managed Medicare Player Plans No Expansion in Next 5 Years

MANAGED CARE October 1999. ©1999 MediMedia USA

It wasn't long ago that Medicare held a special lure for HMOs, which saw the government's foray into managed care as a lucrative opportunity. But if a PacifiCare decision last month is any indication, Medicare is no longer the golden egg.

The company's five-year strategic plan calls for aggressive expansion in the commercial market — PacifiCare wants to boost its employer-based business 47 percent — but no such grandiosity is slated for the Medicare side. PacifiCare's Secure Horizons HMO, which enrolls more than 1 of every 6 people in Medicare+Choice, is the biggest player in managed Medicare. But with tighter capitation rates squeezing HMOs, PacifiCare is thinking about balancing its revenue stream. Almost $3 of every $5 PacifiCare collects is from Medicare.

PacifiCare's plan puts an exclamation point on HMOs' continuing disenchantment with Medicare. Many of PacifiCare's competitors and other plans have left lower-paying counties or dropped out of Medicare altogether in the last year, disrupting coverage for more than 700,000 elderly.

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