Program management (81 - 90 of 126 items)
Medicare Demonstration PPOs: Financial and Other Advantages for Plans, Few Advantages for Beneficiaries
GAO-04-960: Published: Sep 27, 2004. Publicly Released: Sep 27, 2004.
Preferred provider organizations (PPO) are more prevalent than other types of health plans in the private market, but, in 2003, only six PPOs contracted to serve Medicare beneficiaries in Medicare+Choice (M+C), Medicare's private health plan option. In recent years, the Centers for Medicare & Medicaid Services (CMS), the agency that administers Medicare, initiated two demonstrations that include a...
Medicare: Divided Authority for Policies on Coverage of Procedures and Devices Results in Inequities
GAO-03-175: Published: Apr 11, 2003. Publicly Released: May 12, 2003.
Critical choices on whether new technology will be covered for Medicare's 40 million beneficiaries are made nationally by the Centers for Medicare & Medicaid Services (CMS)--the agency that administers Medicare--or locally by contractors that process and pay claims. GAO was asked to review the degree to which new procedures and devices are incorporated into Medicare, the effect of Medicare coverag...
Smallpox Vaccination: Implementation of National Program Faces Challenges
GAO-03-578: Published: Apr 30, 2003. Publicly Released: Apr 30, 2003.
Amid growing concerns about a potential smallpox attack, the Centers for Disease Control and Prevention (CDC) is working with 62 state, local, and territorial jurisdictions to implement the civilian part of the National Smallpox Vaccination Program. The goal is to increase the nation's response capacity by vaccinating health workers for Smallpox Response Teams as quickly as is safely possible. A c...
Defense Health Care: Oversight of the Adequacy of TRICARE's Civilian Provider Network Has Weaknesses
GAO-03-592T: Published: Mar 27, 2003. Publicly Released: Mar 27, 2003.
During 2002, in testimony to the House Armed Services Committee, Subcommittee on Personnel, beneficiary groups described problems with access to care from TRICARE's civilian providers, and providers testified about their dissatisfaction with the TRICARE program, specifying low reimbursement rates and administrative burdens. The Bob Stump National Defense Authorization Act of 2003 required that GAO...
Medicare Outpatient Drugs: Program Payments Should Better Reflect Market Prices
GAO-02-531T: Published: Mar 14, 2002. Publicly Released: Mar 14, 2002.
In some cases, Medicare pays significantly more for covered outpatient drugs than the actual costs to the physicians and pharmacy suppliers. Attempts to reduce these payments have been met with provider claims that overpayments for the drugs are needed to cover underpayments for administering or delivering them. Medicare's method for establishing drug payments is flawed. Medicare pays 95 percent o...
Medicare: Successful Reform Requires Meeting Key Management Challenges
GAO-01-1006T: Published: Jul 25, 2001. Publicly Released: Jul 25, 2001.
Management of Medicare has come under increasing scrutiny. The Health Care Financing Administration (HCFA) has had mixed success running the program. The agency has developed payment methods that have contained cost growth, and HCFA has paid fee-for-service claims quickly and at low administrative cost. However, HCFA has had difficulty ensuring that it paid claims appropriately. In addition, Medic...
Medicare: 21st Century Challenges Prompt Fresh Thinking About Program's Administrative Structure
T-HEHS-00-108: Published: May 4, 2000. Publicly Released: May 4, 2000.
Pursuant to a congressional request, GAO discussed ways to improve the administration of the Medicare program, focusing on the: (1) issues the Health Care Financing Administration (HCFA) faces in administering the Medicare program; and (2) extent to which proposed reforms or alternative models might address these issues.GAO noted that: (1) Medicare is an inherently difficult program to manage, reg...
Defense Health Care: Health Promotion in DOD and the Challenges Ahead
HRD-91-75: Published: Jun 4, 1991. Publicly Released: Jun 4, 1991.
Pursuant to a congressional request, GAO reviewed the Department of Defense's (DOD) health promotion program, focusing on whether: (1) it addressed the military services' major health concerns; (2) the program and selected private health promotion programs compared favorably with respect to content and organization; (3) prior health promotion studies analyzed the costs and benefits of health promo...
U.S. Employees Health Benefits: Status of Contractor's Nonlegislative Recommendations to Reduce Costs
HRD-89-6: Published: Dec 19, 1988. Publicly Released: Jan 19, 1989.
In response to a congressional request, GAO provided information on the Office of Personnel Management's (OPM) efforts to implement a contractor's nonlegislative recommendations to correct problems in the Federal Employees Health Benefits Program (FEHBP).GAO found that OPM: (1) expressed concern that implementing uniform cost-containment measures could result in the loss of enrollees to plans usin...
Medicaid: Early Problems in Implementing the Philadelphia HealthPASS Program
HRD-88-37: Published: Dec 22, 1987. Publicly Released: Dec 22, 1987.
In response to a congressional request, GAO reviewed Pennsylvania's progress and problems in implementing the Philadelphia Accessible Services System (HealthPASS), a contractor-operated program that manages and coordinates delivery of prepaid health care services to Medicaid recipients.GAO found that the contractor: (1) obtained a 2-year waiver of Medicaid regulations to administer HealthPASS as a...