Managed health care (41 - 50 of 86 items)
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...
NIH Clinical Trials: Various Factors Affect Patient Participation
HEHS-99-182: Published: Oct 30, 1999. Publicly Released: Nov 1, 1999.
Pursuant to a congressional request, GAO reviewed patient access to clinical trials sponsored by the National Institutes of Health (NIH), focusing on: (1) how health insurers' coverage policies and practices affect patient participation in clinical trials; (2) researchers' experience in enrolling patients for trials sponsored by the National Cancer Institute (NCI) and factors that may explain this...
Medicare Reform: Ensuring Fiscal Sustainability While Modernizing the Program Will be Challenging
T-HEHS/AIMD-99-294: Published: Sep 22, 1999. Publicly Released: Sep 22, 1999.
Pursuant to a congressional request, GAO discussed efforts to reform the administration, structure, and financing of the Medicare program.GAO noted that: (1) in March, the Bipartisan Commission on the Future of Medicare completed its deliberations; (2) reform options emerged from these discussions that touched on all aspects of the Medicare program, including: (a) modernization of the traditional...
Defense Health Care: Claims Processing Improvements Are Underway but Further Enhancements Are Needed
HEHS-99-128: Published: Aug 23, 1999. Publicly Released: Aug 23, 1999.
Pursuant to a congressional request, GAO reviewed the timeliness and accuracy of the Department of Defense's (DOD) health care claims processing procedures.GAO noted that: (1) between July 1, 1997, and June 30, 1998, DOD's contractors processed 86 percent of claims within 21 days; (2) this met DOD's timeliness standard of processing 75 percent of claims within 21 days; (3) even so, nearly 3 millio...
Medicare Subvention: Challenges and Opportunities Facing a Possible VA Demonstration
T-HEHS/GGD-99-159: Published: Jul 1, 1999. Publicly Released: Jul 1, 1999.
Pursuant to a congressional request, GAO discussed the Department of Veterans Affairs (VA) Medicare subvention demonstration proposal, focusing on: (1) comparing the 1998 House Ways and Means Committee bill on VA subvention with the Senate Finance Committee proposal; (2) the unique characteristics of VA health care that bear on subvention; and (3) the lessons learned from the design and early impl...
Medicare+Choice: Reforms Have Reduced, but Likely Not Eliminated, Excess Plan Payments
HEHS-99-144: Published: Jun 18, 1999. Publicly Released: Jun 22, 1999.
Pursuant to a congressional request, GAO reviewed concerns surrounding the Balanced Budget Act's (BBA) health plan payment changes, focusing on: (1) the extent to which health plans provide additional benefits and whether they could continue to provide additional benefits if payments were reduced; (2) the evidence regarding managed care's effect on Medicare spending; and (3) whether BBA provisions...
Medicare: Options for Reform
T-HEHS-99-130: Published: May 26, 1999. Publicly Released: May 26, 1999.
Pursuant to a congressional request, GAO discussed efforts to reform the Medicare program, focusing on: (1) a conceptual framework for considering the various possible combinations of reform options; and (2) lessons about implementing reforms learned from recent Medicare experience.GAO noted that: (1) options to reform Medicare have two major dimensions: (a) expansion of Medicare's benefit package...
Medicare Managed Care Plans: Many Factors Contribute to Recent Withdrawals; Plan Interest Continues
HEHS-99-91: Published: Apr 27, 1999. Publicly Released: Apr 27, 1999.
Pursuant to a congressional request, GAO provided information on managed care plans' decisions to leave the Medicare program or to reduce the geographic areas that they serve, focusing on: (1) plans that receive capitated payments; (2) the patterns of plan and beneficiary participation in managed care; (3) factors associated with plans' decisions to enter or leave the Medicare Choice program; and...
Medicare+Choice: HCFA Actions Could Improve Plan Benefit and Appeal Information
T-HEHS-99-108: Published: Apr 13, 1999. Publicly Released: Apr 13, 1999.
Pursuant to a congressional request, GAO discussed the: (1) accuracy, completeness, and usefulness of the information Medicare managed care organizations (MCO) distribute about their plans' benefit packages; (2) extent to which MCOs inform beneficiaries of their plan appeal rights and the appeals process; and (3) Health Care Financing Administration's (HCFA) review, approval, and oversight of the...
Medicare + Choice: New Standards Could Improve Accuracy and Usefulness of Plan Literature
HEHS-99-92: Published: Apr 12, 1999. Publicly Released: Apr 13, 1999.
Pursuant to a congressional request, GAO provided information on the Medicare Choice program, focusing on: (1) the extent to which managed care organizations' (MCO) member literature provides beneficiaries with accurate and useful plan information; and (2) whether the Health Care Financing Administration's (HCFA) review process ensures that beneficiaries can rely on MCOs' member literature to make...