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How ready are health plans for Medicare?
G Gaumer1, T Moore, M Friedman
1Health Care Associates Plus, Cambridge, MA, USA.
Context:
The Medicare program is encouraging its beneficiaries to enroll in capitated health plans.
Objective:
To determine how prepared these plans are to handle chronically ill and frail elderly persons.
Design:
Telephone survey of 28 health plans that together serve about one fourth of all enrollees of the Medicare Risk program.
Measures:
The degree of readiness (high, intermediate, or low) of health plans in seven domains that experts believe are important to the management of an elderly population.
Results:
None of the 28 health plans had high readiness scores for all seven domains. The two domains for which the plans were most prepared were risk assessment and member self-care. The plans were least prepared for the domains of cooperative team care and geriatric consultations.
Conclusions:
Many plans do not offer the programs that experts believe are important for Medicare enrollees. They may hesitate to adopt strategies that lack data on effectiveness.
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