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Managed Care
February 2006 |
Managed Care Offered to More Medicaid Enrollees A chart illustrates the percentage of medicaid enrollees in managed care, for the years 1996 to 2004.   |
Managed Care
April 2005 |
Medicare Modernization Act to Increase Public Sector Spending Nearly 50 Percent While the burden on the public sector to supply health care benefits to Medicare and Medicaid enrollees will increase, on the private side, a reevaluation of current forms of health insurance coverage may take place as growth in premiums continues to outpace growth in compensation. |
Managed Care
November 1999
Richard Hamer |
Goals 2000: For HMOs: Administrative Retooling For MDs: Managerial Competency ...While HMOs retrench, physicians need to become more constructive participants.... |
Managed Care
November 2003 |
Study Says PPOs Don't Mix Well With Medicare Despite the will and wishes of many members of Congress, Medicare and preferred-provider organizations will not mix well, Mathematica Policy Research warns in a recent report. |
Managed Care
October 2002 |
Though M+C Erosion Slows, Reimbursement Still an Issue The exodus of health plans from Medicare+Choice will moderate somewhat next year, offering hope that the struggling system can make a comeback. |
Managed Care
March 2002 |
M+C Enrollees Bound to Their Choice Until June A lock-in mechanism for Medicare+Choice that kicked in Jan. 1 narrows the period during which enrollees can switch from health plan to health plan... |
Managed Care
April 2000 |
Fallout from the "new economy": claims payment slower than ever A new InterStudy Publications report says HMOs relied heavily on investor funds during the 1990s to cover medical and operational expenses, and premiums alone were not enough. The resulting cash crunch means health plans are taking longer than ever to pay claims... |
Managed Care
September 2003 |
Medicare+Choice expenses increasing for enrollees Those who argue that Medicare and managed care don't mix well have new data to take to the fight. A Commonwealth Fund report states that the average out-of-pocket costs for Medicare+Choice enrollees soared 10 percent this year. |
Managed Care
January 2001
David Ricks & Joe Suminski |
Nowhere To Go but Out? Tracking Medicare+Choice Managed Medicare's trouble may have something to do with underfunding or rich benefits, but for health plans, market share has a lot to do with it, too... |
Managed Care
July 2004 |
Headlines On Deadline ... In a major victory for HMOs, the Supreme Court voted unanimously on June 21 that patients may not sue health plans in state courts for refusing to pay for medical care recommended by physicians. |
Managed Care
December 2004 |
Headlines On Deadline ... Preferred Provider Organizations participating in Medicare Advantage can satisfy federal oversight requirements if they've already received accreditation from the National Committee for Quality Assurance. |
Managed Care
February 2002 |
Hospital costs lead way in health care expenditures The share of the gross domestic product attributed to health care increased slightly more than overall GDP growth from 1999 to 2000 -- the first time that's happened in nine years... |
Managed Care
May 2007
Frank Diamond |
Medicare Advantage Hits Jackpot with Private Fee-for-Service Plans The secret to the success of Medicare private fee-for-service plans is as old as gold. Will beneficiary satisfaction force Congress to keep the faucet turned on? |
Managed Care
June 2003 |
HMO, Medicaid formularies exhibit surprisingly small differences When you compare HMO and Medicaid formularies for coverage in major therapeutic areas, you find that the differences are relatively small, with Medicaid plans being somewhat less stringent. |
Financial Planning
November 1, 2007
Donald Jay Korn |
Medicare Choices What are Medicare private fee-for-service plans and why did their fortunes rise and fall so dramatically? Most important, if these plans survive in their current form, should advisors suggest them for clients enrolled in or approaching Medicare eligibility? |
Managed Care
July 2000
Michael Levin-Epstein |
Congress Asked To Take Action As HMOs Flee Managed Medicare Thanks mainly to the increasing cost of providing a prescription drug benefit, HMOs are exiting Medicare+Choice, the system that was supposed to manage the health of the nation's senior citizens, in droves. Only an act of Congress can save Medicare+Choice, but is seems doubtful that will happen. |
Managed Care
July 2002 |
Memo Clarifies CMS Guidelines on Injectables Injectable drugs should be covered by Medicare if beneficiaries administer them less than 50 percent of the time, according to a clarification on this issue by the Centers for Medicare and Medicaid services that's set to take effect Aug. 1. |
Managed Care
November 2001 |
Medicare+Choice Problems Chasing Away 58 Health Plans Medicare+Choice, the program that was supposed to ease the elderly into managed care, is itself suffering from the uneasiness of HMOs dissatisfied with payment rates... |
Managed Care
July 2002 |
CBO Weighs Effect of Growing Deficit on Fed Programs Health care programs such as Medicare and Medicaid figure to suffer, thanks to a growing federal budget deficit, according to a report by the Congressional Budget Office. |
Managed Care
April 2000 |
Financial Stability Of HMOs Called A Mixed Bag An HCIA-Sachs survey says the median HMO profit margin in 1998 was -1.7 percent, slightly better than in 1997. Forty-one percent of HMOs made money in 1998.... |
Managed Care
July 2004
Martin Sipkoff |
Managed Medicaid Business Might Be Worth the Difficulties Financial, regulatory, and access problems continue. Still, this remains a growth industry and some have found a way to profit. |
Managed Care
April 2002
Frank Diamond |
Medicare+Choice: Uncertain Future for Unstable Program While policy makers haggle over President Bush's budget request for the system, an ominous question looms: Can money solve all the problems? |
Managed Care
February 2002 |
Nutrition Help Now Covered By Medicare In a move that may eventually influence benefits packages offered by private insurers, Medicare this year expanded preventive services to include nutrition therapy and pain management for some patients... |
Managed Care
January 2001 |
More HMOs to fold, consolidate in 2001 More than six dozen HMOs have characteristics that put them in danger of going out of business, according to projections by InterStudy publications... |
The Motley Fool
February 24, 2009
Brian Orelli |
Health Insurers Hammered. Again. Health insurers were blown away by the Centers for Medicare and Medicaid Services' announcement that it plans to raise the 2010 Medicare Advantage payment rates by only 0.5%. |
Managed Care
August 2006 |
Headlines On Deadline ... Aetna is unveiling something it calls the Medicare Open Plan, targeted for employers who want to offer retirees age 65 or over a fee-for-service Medicare Advantage plan. |
The Motley Fool
November 18, 2010
Brian Orelli |
Worry-Free Dendreon? One step closer to national reimbursement from the Centers for Medicare and Medicaid Services to pay for its prostate cancer treatment Provenge. |
Managed Care
August 2002 |
24 States Hope Pharmacy Plus Helps Medicaid Twenty-four states may gamble that providing a prescription drug program to low-income elderly who do not qualify for Medicaid could save them money in the long run. |
Managed Care
April 2004 |
Medicaid DM To Get Boost From CMS The federal government plans to give Medicaid disease management a lift by matching the money states pay to run such programs. |
Managed Care
February 2004 |
Access Equal In For-Profits, Not-For-Profits? Scientific studies sometimes produce surprising conclusions, and one published last month in the New England Journal of Medicine, indicating that for-profit health plans involved in Medicare+Choice provide just as much access to high-cost medical procedures as not-for-profit competitors, certainly did. |
Managed Care
February 2001 |
In Medicare Bill, HMOs Got What They Wanted When the dust cleared over how $35 billion in Medicare "givebacks" would be divided, the Republicans prevailed -- Medicare HMOs got a bigger cut than Democrats wanted to give them. Now, President Bush may be poised to give Medicare managed care plans more... |
Managed Care
September 2005 |
HMO Profits up, But at a Much Slower Rate Overall, the HMOs' profits increased 10.7 percent in 2004, according to data collected from 515 managed care organizations. |
Managed Care
January 2007 |
Headlines on Deadline ... State budgets got an unexpected gift last year... Mortality rates for hospitals ranked high... It looks likely that Massachusetts Gov. Mitt Romney will run for president... etc. |
Managed Care
May 2002
Frank Diamond |
Medicare+EvenMoreChoice: U.S. Encourages PPO Option The government offers financial incentives that include $100,000 in seed money, risk-sharing deals, and higher payment rates |
Managed Care
December 2003
John A. Marcille |
Will a Gift From Congress Rebuild Public Confidence? Medicare reform is another way of digging out from under the PR muck. Make it work, make it better than it was before and even the industry's harshest critics will have to admit that managed care does good while it does well. Failure is not an option. |
Managed Care
February 2002 |
Where HMOs go head to head Almost three quarters (74.2 percent) of the 72.3 million HMO members in metropolitan areas are in large markets... |
Managed Care
February 2006 |
Medicare's Efficiency Over-Hyped, Study Claims The belief that Medicare is a more efficient system than employee-sponsored health insurance comes under fire in a study that claims there are hidden costs in the government program. |
Managed Care
October 2001 |
CMS Defends Plan To Let States Tailor Medicaid Benefits Centers for Medicare and Medicaid Services Administrator Thomas Scully has defended the Bush administration's plan to allow states to opt out of mandatory Medicaid-coverage requirements... |
Managed Care
May 2007
John Marcille |
Pay for Performance Proceeds at Proper Pace The incrementalist pay-for-performance will be with us long after Medicare private fee-for-service plan is history. |
Managed Care
April 2002 |
More Than Just 'Chipping' Away at Problem of Uninsured Children CHIP (the Children's Health Insurance Program) continues to grow by leaps and bounds. About 4.6 million children in the U.S. received coverage through CHIP in fiscal year 2001. That's an increase of 38 percent from fiscal year 2000... |
Managed Care
January 2001 |
Study: Elderly Exit When They Exceed Rx Benefit Cap In a study that confirms what has long been assumed, Medicare HMO enrollees become more likely to drop their carriers when they exceed annual pharmacy-benefit caps... |
Managed Care
December 2001 |
CMS Medicaid Managed Care Proposal Under Close Scrutiny Bioterrorism. Medicaid managed care plans. No link between them? Guess again. It all has to do with how proposed Medicaid regulations would affect patients' rights and funding for Medicaid programs ranging from nursing home care to emergency rooms... |
Managed Care
June 2001 |
Few Seem To Use POS Option To Go Out of Network Point-of-service plans, in which members can see an out-of-network provider for higher out-of-pocket cost, are among the options employers offer with increasing frequency... |
Managed Care
November 1999
Uwe Reinhardt, Ph.D. |
Defined Contributions Will Point Employees Toward 'Health Marts' Companies will want to distance themselves from insurance entanglements, giving employees little option but to become more involved.... |
Managed Care
August 2001 |
HMO-CMO Salary Survey How nice to be the chief medical officer of a large commercial HMO in or near Minnesota... |
Managed Care
May 2000
Michael Levin-Epstein |
Marketing Medicare+Choice? Mind Your Ps and Qs, Says OIG A lot of Medicare HMOs' marketing materials don't cut it, says a report by the Office of the Inspector General. It adds that the Health Care Financing Administration is partly to blame.... |
Managed Care
December 2006 |
Compensation Monitor More than half of the nation's HMOs use pay-for-performance programs. |
The Motley Fool
April 7, 2009
Brian Orelli |
Thanks for Nothing, CMS Insurers like Humana, Coventry Health Care, and UnitedHealth Group are going to have to raise the prices of their Medicare Advantage plans to keep their margins at a reasonable level. |
Managed Care
November 1999 |
Medicare Reform Dead for Now On Capitol Hill |
Managed Care
May 2005 |
Medicare PPOs Face Challenge to Funding All the excitement in the industry about Medicare PPOs died in a hurry last month as the Medicare Payment Advisory Committee (MedPAC) moved closer to recommending that the $10 billion fund for the program be eliminated. |
