Managed health care (71 - 80 of 203 items)
Medicare Subvention Demonstration: Pilot Satisfies Enrollees, Raises Cost and Management Issues for DOD Health Care
GAO-02-284: Published: Feb 11, 2002. Publicly Released: Feb 11, 2002.
The Department of Defense's (DOD) Medicare subvention demonstration tested alternate approaches to health care coverage for military retirees. Retirees could enroll in new DOD-run Medicare managed care plans, known as TRICARE Senior Prime, at six sites. The demonstration plan offered enrollees the full range of Medicare-covered services as well as additional TRICARE services, with minimal copaymen...
Medicare + Choice: Recent Payment Increases Had Little Effect on Benefits or Plan Availability in 2001
GAO-02-202: Published: Nov 21, 2001. Publicly Released: Dec 4, 2001.
The number of contracts under Medicare's managed care program--Medicare+Choice (M+C)--fell from 340 to 180 between 1998 and 2001. The reduction reflected decisions by some managed care organizations (MCOs) to terminate selected contracts or to discontinue service in some covered areas. Although nearly all MCOs renewed at least some of their Medicare contracts over this period, many reduced the geo...
Medicare Subvention Demonstration: DOD Costs and Medicare Spending
GAO-02-67: Published: Oct 31, 2001. Publicly Released: Oct 31, 2001.
The Balanced Budget Act of 1997 authorized the Department of Defense (DOD) to conduct the Medicare subvention demonstration for a three-year period. Under this demonstration, DOD formed Medicare managed care organizations--collectively called TRICARE Senior Prime--at six sites that provided the full range of Medicare-covered services as well as additional DOD-covered services, notably prescription...
Medicare Subvention Demonstration: Greater Access Improved Enrollee Satisfaction but Raised DOD Costs
GAO-02-68: Published: Oct 31, 2001. Publicly Released: Oct 31, 2001.
In the Balanced Budget Act of 1997, Congress established a three-year demonstration, called Medicare subvention, to improve the access of Medicare-eligible military retirees to care at military treatment facilities (MTF). The demonstration allowed Medicare-eligible retirees to get their health care largely at MTFs by enrolling in a Department of Defense (DOD) Medicare managed care organization kno...
Medicare+Choice Audits: Lack of Audit Follow-up Limits Usefulness
GAO-02-33: Published: Oct 9, 2001. Publicly Released: Oct 9, 2001.
The Centers for Medicare and Medicaid Services (CMS) spent about $35 billion in 2000 on the Medicare+Choice program--the managed care alternative to Medicare's fee-for-service program. During that time, almost 6.3 million Medicare beneficiaries were enrolled in health plans offered by managed care organizations (MCO) that participate in the Medicare+Choice program. Each year, any MCO choosing to...
Medicare: Improvements Needed in Provider Communications and Contracting Procedures
GAO-01-1141T: Published: Sep 25, 2001. Publicly Released: Sep 25, 2001.
Complete, accurate, and timely communication of program information is necessary to help Medicare providers comply with program requirements and appropriately bill for their services. Information provided to physicians about billing and payment policies is often incomplete, confusing, out of date, or even incorrect. GAO found that the rules governing Centers for Medicare and Medicaid Services (CMS...
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...
Medicare Subvention Demonstration: DOD's Pilot HMO Appealed to Seniors, Underscored Management Complexities
GAO-01-671: Published: Jun 14, 2001. Publicly Released: Jun 14, 2001.
This interim report reviews the implementation of the Department of Defense (DOD) Medicare Subvention Demonstration. GAO found that the demonstration sites were successful in operating Medicare managed care plans. Officials put substantial effort into meeting Medicare managed care requirements and, according to Health Care Financing Administration reviewers, were generally as successful as other n...
Mental Health: Community-Based Care Increases for People With Serious Mental Illness
GAO-01-224: Published: Dec 19, 2000. Publicly Released: Dec 19, 2000.
Between 1987 and 1997, the growth in mental health spending in the United States roughly paralleled the growth in overall health care spending. However, federal mental health spending grew at more than twice the rate of state and local spending. This led to the federal government's share surpassing that of state and local governments, while the share attributable to private sources declined slight...
Medicare+Choice: Oversight Lapses in HCFA's Review of Humana's 1998 Florida Contract
GAO-01-176R: Published: Nov 27, 2000. Publicly Released: Nov 27, 2000.
Humana, Inc., a large Medicare Choice Plan, provided a prescription drug benefit with a coverage limit that was below the amount listed in its 1998 Florida Medicare Choice contract. Ernst and Young, the contractor hired by the Health Care Financing Administration (HCFA) to review Humana's contract submission, did not detect the discrepancies because it failed to follow HCFA's review procedures. HC...