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Medigap preferred provider organizations: issues, implications, and early experience.
L Nelson1, G Swearingen, M Sing
1Mathematica Policy Research, Inc., Washington, DC 20024.
Health Care Financing Review
|February 3, 1992
Summary
The Medicare Physician Preferred Provider Organization (PPO) Demonstration explores PPO options for Medicare beneficiaries. Initial findings assess the viability of linking PPO plans with Medigap insurance, identifying challenges and potential government actions.
Area of Science:
- Health Services Research
- Health Insurance Policy
Background:
- Medicare beneficiaries may benefit from managed care options.
- The Health Care Financing Administration is exploring new Medicare program structures.
Purpose of the Study:
- To assess the feasibility and desirability of a Preferred Provider Organization (PPO) option under Medicare.
- To evaluate the initial experience and viability of a "medigap PPO" model.
Main Methods:
- The study describes a demonstration project involving a Preferred Provider Organization (PPO) linked with a Medigap insurance plan.
- It provides a preliminary assessment of the national viability and effectiveness of medigap PPOs.
Main Results:
- One site is operational, offering a "medigap PPO" through Blue Cross and Blue Shield of Arizona.
- Initial experiences and a preliminary assessment of national viability are presented.
Conclusions:
- Medigap PPOs present potential benefits and challenges for Medicare.
- Impediments to development and effectiveness are identified, with potential government actions discussed.