Managed health care (21 - 30 of 107 items)
Medigap Insurance: Plans Are Widely Available but Have Limited Benefits and May Have High Costs
GAO-01-941: Published: Jul 31, 2001. Publicly Released: Jul 31, 2001.
To protect themselves against large out-of-pocket expenses and help fill gaps in Medicare coverage, most beneficiaries buy supplemental insurance, known as Medigap; contribute to employer-sponsored health benefits to supplement Medicare coverage; or enroll in private Medicare+Choice plans rather than traditional fee-for-service Medicare. Because Medicare+Choice plans are not available everywhere...
DOD and VA Pharmacy: Progress and Remaining Challenges in Jointly Buying and Mailing Out Drugs
GAO-01-588: Published: May 25, 2001. Publicly Released: May 25, 2001.
The Department of Veterans Affairs (VA) and the Department of Defense (DOD) have made important progress, particularly during the past year, in their efforts to jointly procure drugs to help control spiraling prescription drug costs. Although their collaborative efforts have been impressive, the two agencies have largely targeted generic drugs, which comprise less than 10 percent of their combined...
Defense Health Care: Across-the-Board Physician Rate Increases Would be Costly and Unnecessary
GAO-01-620: Published: May 24, 2001. Publicly Released: May 24, 2001.
This report describes the financial and management impact of increasing physician reimbursement rates in TRICARE -- the military's managed health care program. GAO found that changing the TRICARE reimbursement rate nationally to the 70th percentile of billed charges would be costly, inflationary, and largely unnecessary. Such an increase could cost the Defense Department (DOD) and its beneficiarie...
Defense Health Care: Opportunities to Reduce TRICARE Claims Processing and Other Costs
T-HEHS-00-138: Published: Jun 22, 2000. Publicly Released: Jun 22, 2000.
Pursuant to a congressional request, GAO discussed opportunities to reduce claims processing and other costs of the Department of Defense's (DOD) managed health care program--TRICARE, focusing on: (1) the cost of processing TRICARE claims; (2) opportunities that potentially can reduce costs and improve service to beneficiaries, namely increased anti-fraud efforts and more joint procurement of phar...
Medicaid Managed Care: Challenges in Implementing Safeguards for Children With Special Needs
HEHS-00-37: Published: Mar 3, 2000. Publicly Released: Apr 3, 2000.
Pursuant to a congressional request, GAO reviewed the Health Care Financing Administration's (HCFA) and the states' efforts to implement safeguards to protect children with disabilities who are enrolled in Medicaid managed care programs, focusing on the: (1) implications of the Balanced Budget Act of 1997 (BBA) provisions defining this population; (2) number of states enrolling children with speci...
Defense Health Care: Observations on Proposed Benefit Expansion and Overcoming TRICARE Obstacles
T-HEHS/NSIAD-00-129: Published: Mar 15, 2000. Publicly Released: Mar 15, 2000.
Pursuant to a congressional request, GAO discussed proposed changes and improvements to the military health system (MHS), focusing on: (1) the various proposals to expand the military health care benefit, especially those for older retirees, including describing the nature of the enhancement, the present or potential challenges in implementing these proposals, and overall cost implications; (2) th...
Skilled Nursing Facilities: Medicare Payment Changes Require Provider Adjustments But Maintain Access
HEHS-00-23: Published: Dec 14, 1999. Publicly Released: Dec 14, 1999.
Pursuant to a congressional request, GAO provided information on skilled nursing facilities, focusing on: (1) the initial effect of the skilled nursing facility (SNF) prospective payment system (PPS) on Medicare beneficiaries' access to care; (2) the initial effect of the SNF PPS on providers; and (3) the role the SNF PPS has played in the poor financial performance of large nursing home chains.GA...
VA Health Care: VA's Management of Drugs on Its National Formulary
HEHS-00-34: Published: Dec 14, 1999. Publicly Released: Dec 14, 1999.
Pursuant to a congressional request, GAO reviewed how the Department of Veterans' Affairs' (VA) manages its national formulary and how drugs other than those on the formulary are made available to veterans.GAO noted that: (1) VA's national formulary is administered by the Pharmacy Benefits Management Strategic Healthcare Group (PBM), a strategy modeled after one commonly used in private health car...
Medicaid Managed Care: Four States' Experiences With Mental Health Carveout Programs
HEHS-99-118: Published: Sep 17, 1999. Publicly Released: Sep 17, 1999.
Pursuant to a congressional request, GAO provided information on how states design and monitor Medicaid mental health programs, and how, at the federal level, the Health Care Financing Administration (HCFA) exercises its oversight of the Medicaid program, focusing on: (1) the extent of beneficiary choice in capitated mental health carveouts, the range of covered mental health services, and access...
Defense Health Care: Pharmacy Copayments
HEHS-99-134R: Published: Jun 8, 1999. Publicly Released: Jun 8, 1999.
Pursuant to a congressional request, GAO responded to concerns regarding its previous recommendations proposing that Department of Defense (DOD) pharmacy programs charge copayments for prescription drugs.GAO noted that: (1) the recommendations in GAO's report were designed to correct serious problems in DOD's pharmacy benefit programs and at the same time enable a more flexible and richer benefit...